Provider Demographics
NPI:1215243944
Name:NESHEIM, KYMMBERLY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYMMBERLY
Middle Name:LYNN
Last Name:NESHEIM
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 1:3414 W MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1058
Mailing Address - Country:US
Mailing Address - Phone:402-310-1195
Mailing Address - Fax:
Practice Address - Street 1:3414 W MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1058
Practice Address - Country:US
Practice Address - Phone:402-310-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#SLP6916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist