Provider Demographics
NPI:1245352277
Name:COLETTI, KIMBERLY KIRKHAM (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KIRKHAM
Last Name:COLETTI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KIRKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5801 FASHION BLVD
Mailing Address - Street 2:STE 190
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-314-4736
Mailing Address - Fax:
Practice Address - Street 1:5770 S 250 E # G5G50
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-314-5000
Practice Address - Fax:801-314-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336955-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist