MEDICARE: MRS. KIMBERLY A GRIFFITH SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22002279A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200681320A	OTHER	IN	FIRST STEPS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033393079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY A GRIFFITH SLP

Provider Business Mailing Address
First Line	:	6205 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-438-3586
Fax Number	:	260-432-7046

Provider Business Practice Location Address
First Line	:	6205 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-438-3586
Fax Number	:	877-992-0273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	02/27/2018

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