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General NPI Number Information
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NPI Number | 1063546141
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Entity Type | Individual
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Provider Name | KIMBERLY ANN EGBERTS M.S.CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 500 ROUTE 1 SUITE #23
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City | YARMOUTH
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State | ME
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Zip | 04096-4711
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Country | US
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Telephone | 207-653-8263
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Fax |
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Provider Business Mailing Address
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Address Line | 74 ROCK RIDGE RUN
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City | CUMBERLAND CENTER
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State | ME
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Zip | 04021-3730
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Country | US
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Telephone | 207-829-4763
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Fax | 207-829-4763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP518
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License Number State | ME
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