Provider Demographics
NPI:1215175468
Name:MERTINS, KIMBERLY (MS SLP-CCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MERTINS
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N41W33326 WOODSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9773
Mailing Address - Country:US
Mailing Address - Phone:608-279-9811
Mailing Address - Fax:
Practice Address - Street 1:121 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3303
Practice Address - Country:US
Practice Address - Phone:920-261-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3163-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist