Individual
KIMBERLY M MCCLUSKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
726 N CECIL ST, MEMPHIS, MO 63555-1900
(660) 988-4614
Mailing address
726 N CECIL ST, MEMPHIS, MO 63555-1900
(660) 988-4614
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
002275
IA
235Z00000X
Speech-Language Pathologist
Primary
2010031395
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110921152529004
—
MO
Enumeration date
10/12/2011
Last updated
06/30/2017
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