MEDICARE: MRS. KIMBERLY ANN STAFFORD M.C.D., 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	4054	LA

General Provider Information

NPI Number	:	1629224332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN STAFFORD M.C.D., CCC-SLP

Provider Business Mailing Address
First Line	:	2114 STARLING DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5658
Country	:	US
Telephone Number	:	318-746-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 STARLING DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5658
Country	:	US
Telephone Number	:	318-746-7658
Fax Number	:

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

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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Directions to “ MRS. KIMBERLY ANN STAFFORD M.C.D., CCC-SLP” Practice Location

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