Healthcare Provider Details

I. General information

NPI: 1912132606
Provider Name (Legal Business Name): KIMBERLY ANN SLUDER M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 05/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAPLE ST
FLETCHER NC
28732-9497
US

IV. Provider business mailing address

11 MAPLE ST
FLETCHER NC
28732-9497
US

V. Phone/Fax

Practice location:
  • Phone: 828-687-8399
  • Fax:
Mailing address:
  • Phone: 828-687-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: