Healthcare Provider Details

I. General information

NPI: 1285598664
Provider Name (Legal Business Name): KIMBERLY GENE RYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 FIRCREST DR SE
PORT ORCHARD WA
98366-2641
US

IV. Provider business mailing address

15410 HORSESHOE AVE SW
PORT ORCHARD WA
98367-7132
US

V. Phone/Fax

Practice location:
  • Phone: 360-443-3530
  • Fax:
Mailing address:
  • Phone: 470-645-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: