Individual
MRS. KIMBERLY RICHARDSON GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC/SLP
Contact information
Practice address
73 N MAIN ST, SUITE 3, VICTOR, ID 83455
(208) 201-5621
Mailing address
1371 E 4000 N, DRIGGS, ID 83422-5149
(208) 201-5621
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1143
ID
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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