Provider Demographics
NPI:1881717619
Name:ENSMINGER, KIMBERLY FULLER (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FULLER
Last Name:ENSMINGER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:LUE
Other - Last Name:ENSMINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:9146 COUNTY LANE 209
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-9125
Mailing Address - Country:US
Mailing Address - Phone:417-673-2392
Mailing Address - Fax:
Practice Address - Street 1:411 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-1238
Practice Address - Country:US
Practice Address - Phone:417-673-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist