Provider Demographics
NPI:1902209836
Name:SCHIFANO, KIMBERLY MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:SCHIFANO
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 1:1218 EDBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0049
Mailing Address - Country:US
Mailing Address - Phone:803-339-3630
Mailing Address - Fax:803-281-8877
Practice Address - Street 1:975 MARKET ST STE 201D
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6531
Practice Address - Country:US
Practice Address - Phone:803-339-3630
Practice Address - Fax:803-281-8877
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4449235Z00000X
NC10948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist