Provider Demographics
NPI:1871639526
Name:FARMER, KIMBERLY L (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:FARMER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 WILLOW WOODS DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8965
Mailing Address - Country:US
Mailing Address - Phone:803-634-3029
Mailing Address - Fax:
Practice Address - Street 1:1099 WILLOW WOODS DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8965
Practice Address - Country:US
Practice Address - Phone:803-634-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0465Medicaid