MEDICARE: KIMBERLY DENISE NAHOM MS, 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
1	235Z00000X	Speech-Language Pathologist	2202002681	VA

General Provider Information

NPI Number	:	1386305498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DENISE NAHOM MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3507 SCHUERMAN HOUSE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4728
Country	:	US
Telephone Number	:	850-543-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 FOREST HILL DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5680
Country	:	US
Telephone Number	:	703-278-1001
Fax Number	:

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

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/02/2022

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Directions to “ KIMBERLY DENISE NAHOM MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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