MEDICARE: KIMBERLY KLEEMAN WOOD 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
1	235Z00000X	Speech-Language Pathologist	3031	TN
2	235Z00000X	Speech-Language Pathologist	5634	GA

General Provider Information

NPI Number	:	1982643516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KLEEMAN WOOD SLP

Provider Business Mailing Address
First Line	:	269 SPRINGS XING
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8855
Country	:	US
Telephone Number	:	770-345-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 SPRINGS XING
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8855
Country	:	US
Telephone Number	:	770-345-7796
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY KLEEMAN WOOD SLP” Practice Location

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