Provider Demographics
NPI:1912486291
Name:COLE, KIMBERLEY DAWN (SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:COLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204
Mailing Address - Country:US
Mailing Address - Phone:202-544-5439
Mailing Address - Fax:202-379-1797
Practice Address - Street 1:2301 COLUMBIA PIKE
Practice Address - Street 2:SUITE 125
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:202-544-5439
Practice Address - Fax:202-379-1797
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112289235Z00000X
VA2202010079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112289Medicaid
TX112289OtherCOMMERCIAL INSURANCE