Healthcare Provider Details

I. General information

NPI: 1811807779
Provider Name (Legal Business Name): LOUISE A KIMURA SPEECH LANGUAGE PATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BOYLSTON ST APT 2
CHESTNUT HILL MA
02467-2226
US

IV. Provider business mailing address

90 BOYLSTON ST APT 2
CHESTNUT HILL MA
02467-2226
US

V. Phone/Fax

Practice location:
  • Phone: 617-721-6246
  • Fax:
Mailing address:
  • Phone: 617-721-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: