Provider Demographics
NPI:1932227188
Name:CHUNG, KIMBERLY DIERKS (MS CCC-SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DIERKS
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6249
Mailing Address - Country:US
Mailing Address - Phone:847-293-5572
Mailing Address - Fax:
Practice Address - Street 1:408 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6249
Practice Address - Country:US
Practice Address - Phone:847-293-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632209OtherBCBS ID NUMBER