Healthcare Provider Details

I. General information

NPI: 1770496531
Provider Name (Legal Business Name): MS. TERRI KIMBALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TURN PIKE DR
FOLSOM CA
95630-8012
US

IV. Provider business mailing address

1965 BIRKMONT DR
RANCHO CORDOVA CA
95742-6407
US

V. Phone/Fax

Practice location:
  • Phone: 916-294-9145
  • Fax:
Mailing address:
  • Phone: 916-294-9007
  • Fax: 916-294-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP9010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: