Provider Demographics
NPI:1982752002
Name:SCARSDALE, KIMBERLY CAROLINE (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CAROLINE
Last Name:SCARSDALE
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BLIZZEN LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3236
Mailing Address - Country:US
Mailing Address - Phone:479-295-0316
Mailing Address - Fax:
Practice Address - Street 1:3901 PARKWAY CIR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6362
Practice Address - Country:US
Practice Address - Phone:479-295-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5683235Z00000X
ARSP2769235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist