Provider Demographics
NPI:1841453933
Name:SMITH, KIMBERLY DAWN (MA ED, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA ED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8443
Mailing Address - Country:US
Mailing Address - Phone:859-377-0005
Mailing Address - Fax:
Practice Address - Street 1:422 WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8443
Practice Address - Country:US
Practice Address - Phone:859-377-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3542235Z00000X
KYKY07097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist