Provider Demographics
NPI:1881212694
Name:NEUBAUER, KIMBERLY ADRIENNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ADRIENNE
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1121
Mailing Address - Country:US
Mailing Address - Phone:302-653-2803
Mailing Address - Fax:
Practice Address - Street 1:7 FRONT ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-1121
Practice Address - Country:US
Practice Address - Phone:302-653-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE040000620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist