Provider Demographics
NPI:1356741995
Name:KIMBERLAIN, JILLIAN (AUD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:KIMBERLAIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY
Mailing Address - Street 2:AUDIOLOGY SLOT 113
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-2409
Mailing Address - Fax:501-364-6881
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:AUDIOLOGY SLOT 113
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-2409
Practice Address - Fax:501-364-6881
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#317231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist