Provider Demographics
NPI:1285778118
Name:WATKINS, KIPPERLY GAYLE ANN
Entity type:Individual
Prefix:
First Name:KIPPERLY
Middle Name:GAYLE ANN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 S DORSEY LN
Mailing Address - Street 2:#1076
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3900
Mailing Address - Country:US
Mailing Address - Phone:480-897-6063
Mailing Address - Fax:480-838-0853
Practice Address - Street 1:1600 E WATSON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3147
Practice Address - Country:US
Practice Address - Phone:480-897-6063
Practice Address - Fax:480-838-0853
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38395462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant