Healthcare Provider Details

I. General information

NPI: 1386135408
Provider Name (Legal Business Name): KIMBERLY SLOMAN BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W. UNIVERSITY BLVD. THE SCOTT CENTER
MELBOURNE FL
32901
US

IV. Provider business mailing address

150 W. UNIVERSITY BLVD. THE SCOTT CENTER
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-8106
  • Fax: 321-674-8411
Mailing address:
  • Phone: 321-674-8106
  • Fax: 321-674-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-05-2553
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: