Doctor Name: | MRS. KIMBERLY J KERSHAW |
NPI Number: | 1710321385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | SLP-2361 |
Business Practice Address: | 393 E 2nd N Rexburg, ID - 834401605 |
Business Phone Number: | 2083599570 |
Business Fax Number: | 2083599580 |
Mailing Address: | 393 E 2nd N, REXBURG |
State: | ID |
Postal Code: | 834401605 |
Phone Number: | 2083599570 |
Fax Number: | 2083599580 |
NPI Enumeration Date: | 04/25/2013 |
NPI Last Update Date: | 04/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP-2361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
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 |