Provider Demographics
NPI:1982875282
Name:TRAVER, KIMBERLY SUE (AUD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:TRAVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HEALTH CENTER BUILDING
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0001
Mailing Address - Country:US
Mailing Address - Phone:419-372-2515
Mailing Address - Fax:419-372-8089
Practice Address - Street 1:200 HEALTH CENTER BUILDING
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0001
Practice Address - Country:US
Practice Address - Phone:419-372-2515
Practice Address - Fax:419-372-8089
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01036231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000636OtherSTATE LICENSE
OHA01036OtherSTATE LICENSE