Provider Demographics
NPI:1285884064
Name:WHITE, KIMBERLY ANN (MS-CCC-A)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 N FEDERAL HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6700
Mailing Address - Country:US
Mailing Address - Phone:954-943-9020
Mailing Address - Fax:
Practice Address - Street 1:3170 N FEDERAL HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6700
Practice Address - Country:US
Practice Address - Phone:954-943-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1132231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist