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NPI Code Detail

MEDICARE: MRS. KIMBERLY PARK CF-SLP

MEDICARE: MRS. KIMBERLY PARK CF-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 Pathologist

General Provider Information

NPI Number : 1366004491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY PARK CF-SLP
Provider Business Mailing Address
First Line : 5 W 14TH ST
Second Line :
City : CARROLLTON
State : MO
Zip : 64633-1926
Country : US
Telephone Number : 660-349-5086
Fax Number :
Provider Business Practice Location Address
First Line : 401 MATT WALLER DR
Second Line :
City : RICHMOND
State : MO
Zip : 64085-2270
Country : US
Telephone Number : 816-776-3059
Fax Number : 816-776-2608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2019
Last Update Date : 06/28/2019

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Directions to “ MRS. KIMBERLY PARK CF-SLP” Practice Location

Language Start Address Practice Location
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