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General NPI Number Information
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NPI Number | 1649872292
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Entity Type | Individual
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Provider Name | KIMBERLY IVETTE KUILAN SLPA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 1801 S 23RD ST STE 2
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City | FORT PIERCE
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State | FL
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Zip | 34950-4830
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Country | US
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Telephone | 772-464-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 SE WALTON LAKES DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5106
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Country | US
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Telephone | 787-454-1029
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Fax |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 4206
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License Number State | FL
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