Provider Demographics
NPI:1891233433
Name:NEELY, KIMBERLY DIANE (CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:NEELY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 FREMONT ST
Mailing Address - Street 2:APT. 2807
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2393
Mailing Address - Country:US
Mailing Address - Phone:303-818-8725
Mailing Address - Fax:
Practice Address - Street 1:256 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1409
Practice Address - Country:US
Practice Address - Phone:415-702-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 11266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist