Doctor Name: | KIMBERLY DAYLE ROATEN |
NPI Number: | 1538497789 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 34358 |
Business Practice Address: | 5323 Harry Hines Blvd Dallas, TX - 753907208 |
Business Phone Number: | 2146485594 |
Business Fax Number: | 2146484947 |
Mailing Address: | Po Box 845347, DALLAS |
State: | TX |
Postal Code: | 752845347 |
Phone Number: | 2146455594 |
Fax Number: | 2146484947 |
NPI Enumeration Date: | 11/30/2009 |
NPI Last Update Date: | 11/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 34358 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |