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General NPI Number Information
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NPI Number | 1821402223
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Entity Type | Individual
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Provider Name | KAITLYN KIMREY M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 126 S MAIN ST STE 2A
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City | DAVIDSON
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State | NC
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Zip | 28036-8096
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Country | US
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Telephone | 704-222-6875
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Fax |
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Provider Business Mailing Address
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Address Line | LKN SPEECH LANGUAGE PATHOLOGY 126 S MAIN ST STE 2A
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City | DAVIDSON
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State | NC
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Zip | 28036-8096
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Country | US
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Telephone | 704-222-6875
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1512161
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 11349
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License Number State | NC
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