Doctor Name: | MRS. KIMBERLY NICOLE FOGG |
NPI Number: | 1710323266 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | 4803 |
Business Practice Address: | 1224 Provost Dr Jefferson City, TN - 377603833 |
Business Phone Number: | 8654753686 |
Business Fax Number: | |
Mailing Address: | 1224 Provost Dr, JEFFERSON CITY |
State: | TN |
Postal Code: | 377603833 |
Phone Number: | 8654753686 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2013 |
NPI Last Update Date: | 05/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4803 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
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 |