Provider Demographics
NPI:1801916697
Name:MANER, KIMBERLY JONES (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JONES
Last Name:MANER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 COLONY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-1602
Mailing Address - Country:US
Mailing Address - Phone:704-865-7958
Mailing Address - Fax:
Practice Address - Street 1:1429 E MARION ST
Practice Address - Street 2:STE. 5
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4986
Practice Address - Country:US
Practice Address - Phone:704-480-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139C6OtherBLUECROSS BLUESHIELD