MEDICARE: KIMBERLY ANNE HUMPHREY 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	103978	TX

General Provider Information

NPI Number	:	1891929303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE HUMPHREY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2007 WRIGHT ST
Second Line	:	B
City	:	AUSTIN
State	:	TX
Zip	:	78704-2831
Country	:	US
Telephone Number	:	802-377-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 WRIGHT ST
Second Line	:	B
City	:	AUSTIN
State	:	TX
Zip	:	78704-2831
Country	:	US
Telephone Number	:	802-377-9119
Fax Number	:

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

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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