Provider Demographics
NPI:1184906463
Name:KIMBERLY SCOTT
Entity type:Organization
Organization Name:KIMBERLY SCOTT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:415-713-9011
Mailing Address - Street 1:3208 HIGHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BCH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3833
Mailing Address - Country:US
Mailing Address - Phone:415-713-9011
Mailing Address - Fax:
Practice Address - Street 1:3208 HIGHLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:MANHATTAN BCH
Practice Address - State:CA
Practice Address - Zip Code:90266-3833
Practice Address - Country:US
Practice Address - Phone:415-713-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP-13647OtherSPEECH THERAPY LICENSE NUMBER