Individual
MRS. KIMBERLY ROSE HETTERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D., CCC-A
Contact information
Practice address
251 E OAKLAND AVE, PORT JEFFERSON, NY 11777-2602
(631) 928-0188
(631) 928-0185
Mailing address
30 LONG BEACH DR, SOUND BEACH, NY 11789-1835
(631) 928-0188
(631) 928-0185
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
002295
NY
Other
Enumeration date
06/29/2010
Last updated
07/12/2011
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