Provider Demographics
NPI:1912131160
Name:FEENEY, KIMBERLY ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:FEENEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RENNIE LN
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04010-4937
Mailing Address - Country:US
Mailing Address - Phone:207-615-3293
Mailing Address - Fax:
Practice Address - Street 1:5 RENNIE LN
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:ME
Practice Address - Zip Code:04010-4937
Practice Address - Country:US
Practice Address - Phone:207-615-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist