Provider Demographics
NPI:1669611620
Name:SVENSON, KIMBERLY MAGUIRE (MA, CCC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MAGUIRE
Last Name:SVENSON
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 FOUNDERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1441
Mailing Address - Country:US
Mailing Address - Phone:941-343-0526
Mailing Address - Fax:
Practice Address - Street 1:4064 FOUNDERS CLUB DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1441
Practice Address - Country:US
Practice Address - Phone:941-343-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist