| Doctor Name: | KIMBERLEY-RAE KETCHAM |
| NPI Number: | 1013310929 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSCCC-SLP |
| License Number: | SP3973 |
| Business Practice Address: | 1605 Rockbridge Ct Troy, OH - 453739559 |
| Business Phone Number: | 9377261542 |
| Business Fax Number: | 9375529121 |
| Mailing Address: | 1605 Rockbridge Ct, TROY |
| State: | OH |
| Postal Code: | 453739559 |
| Phone Number: | 9377261542 |
| Fax Number: | 9375529121 |
| NPI Enumeration Date: | 10/06/2014 |
| NPI Last Update Date: | 10/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP3973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |