Doctor Name: | HALEY KIMOCK |
NPI Number: | 1790155570 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | P/SLP-0652 |
Business Practice Address: | 1539 Country Club Rd Fairmont, WV - 265541306 |
Business Phone Number: | 3043638479 |
Business Fax Number: | |
Mailing Address: | 1539 Country Club Rd, FAIRMONT |
State: | WV |
Postal Code: | 265541306 |
Phone Number: | 3043638479 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2015 |
NPI Last Update Date: | 10/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | P/SLP-0652 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
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 |