Healthcare Provider Details

I. General information

NPI: 1912486291
Provider Name (Legal Business Name): KIMBERLEY DAWN COLE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE SUITE 125
ARLINGTON VA
22204
US

IV. Provider business mailing address

2301 COLUMBIA PIKE SUITE 125
ARLINGTON VA
22204
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5439
  • Fax: 202-379-1797
Mailing address:
  • Phone: 202-544-5439
  • Fax: 202-379-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112289
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010079
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: