Provider Demographics
NPI:1316693377
Name:KIMBERLY CARTER THERAPY, INC.
Entity type:Organization
Organization Name:KIMBERLY CARTER THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:318-548-6925
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:SWARTZ
Mailing Address - State:LA
Mailing Address - Zip Code:71281-0591
Mailing Address - Country:US
Mailing Address - Phone:318-548-6925
Mailing Address - Fax:866-434-2902
Practice Address - Street 1:121 ELLINGTON DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3632
Practice Address - Country:US
Practice Address - Phone:318-548-6925
Practice Address - Fax:866-434-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014784Medicaid