Provider Demographics
NPI:1316277452
Name:BARADEI, KIMBERLY A (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BARADEI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KASICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1764 HERITAGE CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4092
Mailing Address - Country:US
Mailing Address - Phone:908-892-3492
Mailing Address - Fax:908-892-8985
Practice Address - Street 1:1764 HERITAGE CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4092
Practice Address - Country:US
Practice Address - Phone:908-892-3492
Practice Address - Fax:908-895-8985
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00540400235Z00000X
NC15561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist