MEDICARE: KIMBERLY SCOTT

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	SP13647	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP-13647	OTHER	CA	SPEECH THERAPY LICENSE NUMBER

General Provider Information

NPI Number	:	1184906463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY SCOTT

Provider Business Mailing Address
First Line	:	3208 HIGHLAND AVE STE B
Second Line	:
City	:	MANHATTAN BCH
State	:	CA
Zip	:	90266-3833
Country	:	US
Telephone Number	:	415-713-9011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 HIGHLAND AVE STE B
Second Line	:
City	:	MANHATTAN BCH
State	:	CA
Zip	:	90266-3833
Country	:	US
Telephone Number	:	415-713-9011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KIMBERLY SCOTT
Credential	:	CCC-SLP
Telephone Number	:	415-713-9011

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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Directions to “KIMBERLY SCOTT ” Practice Location

Language	Start Address	Practice Location

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