Provider Demographics
NPI:1770702151
Name:KIMBERLY A. EGBERTS & ASSOC.
Entity type:Organization
Organization Name:KIMBERLY A. EGBERTS & ASSOC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EGBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:207-653-8263
Mailing Address - Street 1:74 ROCK RIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3730
Mailing Address - Country:US
Mailing Address - Phone:207-829-4763
Mailing Address - Fax:207-829-4763
Practice Address - Street 1:30 FOREST FALLS DR
Practice Address - Street 2:SUITE #1
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6983
Practice Address - Country:US
Practice Address - Phone:207-829-4763
Practice Address - Fax:207-829-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME222350000Medicaid
ME100278Medicare UPIN
MEAA51557Medicare UPIN