Provider Demographics
NPI:1396805339
Name:SNOW, KIM LAUREN (MA)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:LAUREN
Last Name:SNOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3562 W BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1376
Mailing Address - Country:US
Mailing Address - Phone:480-838-4536
Mailing Address - Fax:
Practice Address - Street 1:945 W 8TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3902
Practice Address - Country:US
Practice Address - Phone:480-472-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist