Provider Demographics
NPI:1386770964
Name:STREFF, KIMBERLY SUE (MS, CCC-SLP,BCBA,LBA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:STREFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP,BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LEXINGTON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-1479
Mailing Address - Country:US
Mailing Address - Phone:636-221-9495
Mailing Address - Fax:
Practice Address - Street 1:324 S MASON RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8029
Practice Address - Country:US
Practice Address - Phone:636-221-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114517235Z00000X
MO2013028552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist