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Individual
MRS. KIMBERLY R SMITH
Active
Individual
MRS. KIMBERLY R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
SA11616
FL
235Z00000X
Speech-Language Pathologist
010607-1
NY
235Z00000X
Speech-Language Pathologist
HO451A
FL
235Z00000X
Speech-Language Pathologist
Primary
SA 11616
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010607-1
NEW YORK STATE LICENSE #
NY
01
—
09126830
ASHA CERTIFICATION NUMBER
—
01
—
HO451A
MEDICARE PART B
FL
01
—
SA 11616
STATE OF FLORIDA DEPARTMENT OF HEALTH LICENSE #
FL
Enumeration date
02/06/2007
Last updated
08/11/2017
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