Healthcare Provider Details

I. General information

NPI: 1265079958
Provider Name (Legal Business Name): KIMBERLY COLLEEN SELBA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PATRIOT WAY
NEWARK DE
19711-1809
US

IV. Provider business mailing address

31 HOSIER ST
SELBYVILLE DE
19975-9300
US

V. Phone/Fax

Practice location:
  • Phone: 302-369-2001
  • Fax:
Mailing address:
  • Phone: 302-436-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO1-0001792
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: