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NPI Code Detail

MEDICARE: JAMIE LYNN KIMBALL SLP

MEDICARE: JAMIE LYNN KIMBALL 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 Pathologist2002028071MO

General Provider Information

NPI Number : 1073639779
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LYNN KIMBALL SLP
Provider Business Mailing Address
First Line : 310 US HIGHWAY 61
Second Line :
City : NEW MADRID
State : MO
Zip : 63869-9753
Country : US
Telephone Number : 573-688-2161
Fax Number :
Provider Business Practice Location Address
First Line : 310 US HIGHWAY 61
Second Line :
City : NEW MADRID
State : MO
Zip : 63869-9753
Country : US
Telephone Number : 573-688-2161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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Directions to “ JAMIE LYNN KIMBALL SLP” Practice Location

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