Provider Demographics
NPI:1831784578
Name:LINEWEAVER, KIMBERLY RICE (BC-HIS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RICE
Last Name:LINEWEAVER
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 E BELL RD STE 61
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2312
Mailing Address - Country:US
Mailing Address - Phone:602-953-1422
Mailing Address - Fax:602-788-7831
Practice Address - Street 1:4727 E BELL RD STE 61
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2312
Practice Address - Country:US
Practice Address - Phone:602-953-1422
Practice Address - Fax:602-788-7831
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD4782237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist