Provider Demographics
NPI:1023589678
Name:ZEENDER CHRISTY, KIMBERLY (RD, LD, CLC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ZEENDER CHRISTY
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ZEENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CLC
Mailing Address - Street 1:4200 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6017
Mailing Address - Country:US
Mailing Address - Phone:440-998-7515
Mailing Address - Fax:440-998-0973
Practice Address - Street 1:4200 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6017
Practice Address - Country:US
Practice Address - Phone:440-998-7515
Practice Address - Fax:440-998-0973
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1030543133V00000X
OHLD.7181133V00000X
OHA1020231H00000X
OHSP.04113235Z00000X
OH03022237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH331707Medicaid
OH248305Medicaid
OH345964Medicaid
OH331707Medicaid