Doctor Name: | KRISTIN MICHELE KIMBRO |
NPI Number: | 1558619890 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 35694 |
Business Practice Address: | 911 W Loop 281 Suite 211-12 Longview, TX - 756042900 |
Business Phone Number: | 8003404098 |
Business Fax Number: | 8177896849 |
Mailing Address: | 5316 Trail Lake Dr, FORT WORTH |
State: | TX |
Postal Code: | 761331931 |
Phone Number: | 8172928787 |
Fax Number: | 8177896849 |
NPI Enumeration Date: | 08/16/2012 |
NPI Last Update Date: | 07/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 35694 |
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 |