MEDICARE: MRS. KIMBER MICHELLE STILL 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	P7881	AR
2	235Z00000X	Speech-Language Pathologist	SP#2385	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5Y581	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1659323277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBER MICHELLE STILL CCC-SLP

Provider Business Mailing Address
First Line	:	130 SIGNATURE DR
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8669
Country	:	US
Telephone Number	:	903-293-0927
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 SIGNATURE DR
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8669
Country	:	US
Telephone Number	:	903-293-0927
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/03/2022

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Directions to “ MRS. KIMBER MICHELLE STILL CCC-SLP” Practice Location

Language	Start Address	Practice Location

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