Individual
MRS. JOHNNA L. KIMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
323 S 5TH ST, CLAYTON, NM 88415-2641
(505) 374-9313
(505) 374-8844
Mailing address
101 N 2ND ST, RATON, NM 87740-3803
(505) 445-7090
(505) 445-7663
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4186
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64075362
—
NM
Enumeration date
11/27/2007
Last updated
11/27/2007
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