| Organization Name: | KIMBERLY B WALLACE |
| NPI Number: | 1194971507 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY B. WALLACE (SPEECH PATHOLOGIST) |
| Mailing Address: | 7000 Valley Dr Little Rock |
| State: | AR US |
| Postal Code: | 722097522 |
| Phone Number: | 5014476844 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2008 |
| NPI Last Update Date: | 10/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | AR#521 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| 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 |