Provider Demographics
NPI:1457725574
Name:HARPER, KIMBERLY (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1829
Mailing Address - Country:US
Mailing Address - Phone:501-247-3593
Mailing Address - Fax:
Practice Address - Street 1:8000 ILIFF DR
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1235
Practice Address - Country:US
Practice Address - Phone:703-560-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist