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NPI Code Detail

MEDICARE: MRS. KIMBERLY KAY WALSTON MS/CCC-SLP

MEDICARE: MRS. KIMBERLY KAY WALSTON MS/CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist6041FL

General Provider Information

NPI Number : 1023250776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY KAY WALSTON MS/CCC-SLP
Provider Business Mailing Address
First Line : 500 GRAND PLAZA DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-7900
Country : US
Telephone Number : 407-775-0855
Fax Number :
Provider Business Practice Location Address
First Line : 500 GRAND PLAZA DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-7900
Country : US
Telephone Number : 407-775-0855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2009
Last Update Date : 03/26/2009

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Directions to “ MRS. KIMBERLY KAY WALSTON MS/CCC-SLP” Practice Location

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