Provider Demographics
NPI:1972519403
Name:CUTHBERTSON, KIMBER LEE (SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBER
Middle Name:LEE
Last Name:CUTHBERTSON
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 1:1916 LYNDHURST LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-8515
Mailing Address - Country:US
Mailing Address - Phone:630-851-9853
Mailing Address - Fax:630-851-9853
Practice Address - Street 1:1916 LYNDHURST LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-8515
Practice Address - Country:US
Practice Address - Phone:630-851-9853
Practice Address - Fax:630-851-9853
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
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
IL4528202OtherBLUE CROSS BLUE SHIELD