Provider Demographics
NPI:1942323217
Name:KIERNAN, KIM LUISE (MS CCC-SP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:LUISE
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 SATYR HILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1404
Mailing Address - Country:US
Mailing Address - Phone:410-661-5048
Mailing Address - Fax:
Practice Address - Street 1:9013 SATYR HILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-1404
Practice Address - Country:US
Practice Address - Phone:410-661-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist