Provider Demographics
NPI:1225879885
Name:HINMAN, KERILYN HORTON (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERILYN
Middle Name:HORTON
Last Name:HINMAN
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 1:5035 W CANYON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-5425
Mailing Address - Country:US
Mailing Address - Phone:208-604-3355
Mailing Address - Fax:
Practice Address - Street 1:586 1ST ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3963
Practice Address - Country:US
Practice Address - Phone:208-523-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-6410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist