Provider Demographics
NPI:1740499482
Name:FOX, KIMBERLY SHANTE (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHANTE
Last Name:FOX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 W SHORT 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3218
Mailing Address - Country:US
Mailing Address - Phone:870-329-7344
Mailing Address - Fax:
Practice Address - Street 1:2009 W SHORT 14TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3218
Practice Address - Country:US
Practice Address - Phone:870-329-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist