Healthcare Provider Details

I. General information

NPI: 1740689850
Provider Name (Legal Business Name): KIMBERLY HUGHES SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 BOILING BROOK PKWY
ROCKVILLE MD
20852-2300
US

IV. Provider business mailing address

3207 DECATUR AVE
KENSINGTON MD
20895-2206
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-2710
  • Fax: 301-668-7008
Mailing address:
  • Phone: 202-607-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number04317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: