| Doctor Name: | MRS. KIMBERLY A GREEN |
| NPI Number: | 1346386562 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS,CCC-SLP |
| License Number: | 2002027404 |
| Business Practice Address: | 10560 Old Olive Street Rd Suite 100 Creve Coeur, MO - 631415916 |
| Business Phone Number: | 3145674707 |
| Business Fax Number: | 3145674505 |
| Mailing Address: | 213 Mississippi Ave, CRYSTAL CITY |
| State: | MO |
| Postal Code: | 630191635 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2002027404 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |