Doctor Name: | MRS. KIMBERLY DIANE ANDERSON |
NPI Number: | 1235550773 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS-CCC/SLP |
License Number: | 103642 |
Business Practice Address: | 6601 Harris Pkwy Fort Worth, TX - 761326108 |
Business Phone Number: | 8174339742 |
Business Fax Number: | 8174339699 |
Mailing Address: | 7005 Willis Ave, FORT WORTH |
State: | TX |
Postal Code: | 761168730 |
Phone Number: | 8174339742 |
Fax Number: | |
NPI Enumeration Date: | 12/31/2013 |
NPI Last Update Date: | 12/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 103642 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |