Individual
MS. KIMBERLEY B GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
100 N MAIN ST, SUFFOLK, VA 23434
(757) 925-6764
Mailing address
100 N MAIN ST, SUFFOLK, VA 23434-4529
(757) 925-6764
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202003947
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004979061
—
VA
Enumeration date
09/27/2010
Last updated
09/17/2019
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