Healthcare Provider Details

I. General information

NPI: 1023691060
Provider Name (Legal Business Name): KIMBERLY ANGEL CORTES MS, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY ANGEL COLON MS, CCC/SLP

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 CLOUD HOPPER WAY
LUTZ FL
33559-6875
US

IV. Provider business mailing address

4327 CLOUD HOPPER WAY
LUTZ FL
33559-6875
US

V. Phone/Fax

Practice location:
  • Phone: 732-740-7089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA17636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: