MEDICARE: KIMBERLY SUE NORTON

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
1	235Z00000X	Speech-Language Pathologist	8021	MA

General Provider Information

NPI Number	:	1164739363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUE NORTON

Provider Business Mailing Address
First Line	:	4428 PHEASANT RIDGE RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-5219
Country	:	US
Telephone Number	:	540-400-6430
Fax Number	:

Provider Business Practice Location Address
First Line	:	4428 PHEASANT RIDGE RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-5219
Country	:	US
Telephone Number	:	540-400-6430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	06/03/2020

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Directions to “ KIMBERLY SUE NORTON ” Practice Location

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