Provider Demographics
NPI:1104992502
Name:WALKER, KIMBERLY DELORES (CCC-SLP, QMRP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DELORES
Last Name:WALKER
Suffix:
Gender:F
Credentials:CCC-SLP, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7714 PARKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4724
Mailing Address - Country:US
Mailing Address - Phone:210-694-2528
Mailing Address - Fax:210-694-0590
Practice Address - Street 1:7714 PARKWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-845-3885
Practice Address - Fax:210-694-0590
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101843235Z00000X
CASP0101600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist