Healthcare Provider Details

I. General information

NPI: 1336060508
Provider Name (Legal Business Name): KIMBERLY S SMITH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WINGFIELD HILLS RD APT SUITE
SPARKS NV
89436-7220
US

IV. Provider business mailing address

2350 WINGFIELD HILLS RD APT SUITE
SPARKS NV
89436-7220
US

V. Phone/Fax

Practice location:
  • Phone: 775-335-8275
  • Fax:
Mailing address:
  • Phone: 775-335-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-2121
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: