Individual
MRS. KIMBERLY G KIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1500 W WILLOW ST, SCOTT, LA 70583-5303
(337) 521-7700
(337) 521-7701
Mailing address
112 BELLE GROVE BLVD, LAFAYETTE, LA 70503
(337) 993-3417
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4834
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478202
—
LA
Enumeration date
03/09/2007
Last updated
05/26/2021
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