Provider Demographics
NPI:1194998393
Name:KIM, KIRSTIN
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABLETALK SPEECH AND
Other - Middle Name:LANGUAGE THERAPY
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ABLETALK
Mailing Address - Street 1:6664 LEWEY DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:984-528-6210
Mailing Address - Fax:
Practice Address - Street 1:6664 LEWEY DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:984-528-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2820235Z00000X
NC10329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist