Provider Demographics
NPI:1104328780
Name:WASHINGTON, KIMBERLY SHANTEE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHANTEE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W UNIVERSITY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1891
Mailing Address - Country:US
Mailing Address - Phone:940-387-2939
Mailing Address - Fax:940-387-0434
Practice Address - Street 1:231 W UNIVERSITY DR STE 111
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1891
Practice Address - Country:US
Practice Address - Phone:940-387-2939
Practice Address - Fax:940-387-0434
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist