Provider Demographics
NPI:1891929303
Name:HUMPHREY, KIMBERLY ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 WRIGHT ST
Mailing Address - Street 2:B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2831
Mailing Address - Country:US
Mailing Address - Phone:802-377-9119
Mailing Address - Fax:
Practice Address - Street 1:2007 WRIGHT ST
Practice Address - Street 2:B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2831
Practice Address - Country:US
Practice Address - Phone:802-377-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist