Provider Demographics
NPI:1891826442
Name:OLIVER, KIMBERLY A (SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:OLIVER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3911
Mailing Address - Country:US
Mailing Address - Phone:815-462-1678
Mailing Address - Fax:
Practice Address - Street 1:524 GLENN DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3911
Practice Address - Country:US
Practice Address - Phone:815-462-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932381OtherBCBS