Individual
KIMBERLEY TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2272 N PLEASANTS HIGHWAY, ST. MARYS, WV 26170-0021
(304) 684-2215
Mailing address
2272 N PLEASANTS HIGHWAY, ST. MARYS, WV 26170-0021
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0153241000
—
WV
Enumeration date
04/02/2008
Last updated
04/02/2008
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