Provider Demographics
NPI:1023060407
Name:FAULKENBURG, KIM R (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:R
Last Name:FAULKENBURG
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 VETERANS MEMORIAL DR
Mailing Address - Street 2:AUDIOLOGY SECTION (112A)
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-743-2812
Mailing Address - Fax:254-743-0092
Practice Address - Street 1:1901 VETERANS MEMORIAL DR
Practice Address - Street 2:AUDIOLOGY SECTION (112A)
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-2812
Practice Address - Fax:254-743-0092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50596231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist