Provider Demographics
NPI:1881803674
Name:STOHL, KIMBERLY D (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:STOHL
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 1:9 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-6326
Mailing Address - Country:US
Mailing Address - Phone:860-582-1326
Mailing Address - Fax:
Practice Address - Street 1:2817 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1604
Practice Address - Country:US
Practice Address - Phone:203-757-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist