Healthcare Provider Details

I. General information

NPI: 1619174760
Provider Name (Legal Business Name): KIMBERLY A WRIGHT MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 CERULEAN RD
CADIZ KY
42211-9605
US

IV. Provider business mailing address

141 DAKOTA LN
BENTON KY
42025-6338
US

V. Phone/Fax

Practice location:
  • Phone: 270-522-3236
  • Fax: 270-522-0825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY- 1292
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: