Provider Demographics
NPI:1215159090
Name:KNIPP, KIMBERLY (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KNIPP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 E DONEGAL ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-7212
Mailing Address - Country:US
Mailing Address - Phone:316-209-3859
Mailing Address - Fax:
Practice Address - Street 1:2828 N GOVERNEOUR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1700
Practice Address - Country:US
Practice Address - Phone:316-636-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist