Provider Demographics
NPI:1356186597
Name:SIMMONS, KIMBERLY (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BARRINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7189
Mailing Address - Country:US
Mailing Address - Phone:937-248-8810
Mailing Address - Fax:
Practice Address - Street 1:1025 BARRINGTON RDG
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7189
Practice Address - Country:US
Practice Address - Phone:937-248-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist