Provider Demographics
NPI:1386305498
Name:NAHOM, KIMBERLY DENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:NAHOM
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 1:3507 SCHUERMAN HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4728
Mailing Address - Country:US
Mailing Address - Phone:850-543-3292
Mailing Address - Fax:
Practice Address - Street 1:4310 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5680
Practice Address - Country:US
Practice Address - Phone:703-278-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist