Healthcare Provider Details

I. General information

NPI: 1851339964
Provider Name (Legal Business Name): KIMBERLY FAYE HULL MS, CCC/SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18288 N U.S. HWY 41
LUTZ FL
33549
US

IV. Provider business mailing address

18288 N U.S. HWY 41
LUTZ FL
33549
US

V. Phone/Fax

Practice location:
  • Phone: 813-527-9638
  • Fax: 813-867-7288
Mailing address:
  • Phone: 813-527-9638
  • Fax: 813-867-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0790
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 7688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: