Provider Demographics
NPI:1982075818
Name:SMITH, KIMBERLY ANN GRAHAM (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN GRAHAM
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 40277
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0277
Mailing Address - Country:US
Mailing Address - Phone:251-445-9378
Mailing Address - Fax:251-445-9377
Practice Address - Street 1:5721 USA DR N
Practice Address - Street 2:HAHN 119
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-445-9365
Practice Address - Fax:251-445-9376
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005953235Z00000X
AL3863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist