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General NPI Number Information
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NPI Number | 1831504687
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Entity Type | Individual
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Provider Name | SHAYNE KIMBLE M.C.D. CF-SLP
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 3347 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3842
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Country | US
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Telephone | 318-466-6111
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Fax | 318-466-6113
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Provider Business Mailing Address
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Address Line | 5545 DOWNING ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3159
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Country | US
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Telephone | 318-359-8634
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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 | #7138
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License Number State | LA
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