Doctor Name: | KIMBERLY BEACH STOLLY |
NPI Number: | 1295176311 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC SLP |
License Number: | 7460 |
Business Practice Address: | 804 S Mumaugh Rd Lima, OH - 458043569 |
Business Phone Number: | 4192259040 |
Business Fax Number: | |
Mailing Address: | 5159 Shoshone Trl, LIMA |
State: | OH |
Postal Code: | 458054117 |
Phone Number: | 3035201592 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2013 |
NPI Last Update Date: | 04/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7460 |
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 |