Provider Demographics
NPI:1871645770
Name:DANIELSON, KIMBRE DIANE (MS)
Entity Type:Individual
Prefix:
First Name:KIMBRE
Middle Name:DIANE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KIMBRE
Other - Middle Name:DIANE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 PEGGY DR
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-1243
Mailing Address - Country:US
Mailing Address - Phone:580-225-4557
Mailing Address - Fax:
Practice Address - Street 1:325 PEGGY DR
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-1243
Practice Address - Country:US
Practice Address - Phone:580-225-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK306231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist