MEDICARE: MRS. KIM J. FIERRO 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
1	235Z00000X	Speech-Language Pathologist	3324	NM

General Provider Information

NPI Number	:	1407907363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIM J. FIERRO M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	9309 ASHFALL PLACE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1737
Country	:	US
Telephone Number	:	505-280-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	9309 ASHFALL PLACE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1737
Country	:	US
Telephone Number	:	505-280-3521
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. KIM J. FIERRO M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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