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NPI Code Detail

MEDICARE: MRS. KIMBERLY MARIE MIREK M.S. CCC-SLP

MEDICARE: MRS. KIMBERLY MARIE MIREK M.S. CCC-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
1235Z00000XSpeech-Language Pathologist146007081IL

General Provider Information

NPI Number : 1366440422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY MARIE MIREK M.S. CCC-SLP
Provider Business Mailing Address
First Line : 4736 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53219-4716
Country : US
Telephone Number : 414-306-1410
Fax Number :
Provider Business Practice Location Address
First Line : 4214 SHERIDAN RD
Second Line :
City : RACINE
State : WI
Zip : 53403-4142
Country : US
Telephone Number : 262-515-2434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/21/2008

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Directions to “ MRS. KIMBERLY MARIE MIREK M.S. CCC-SLP” Practice Location

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