Provider Demographics
NPI:1386894731
Name:ROWE, KIMBERLY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-4023
Mailing Address - Country:US
Mailing Address - Phone:912-201-3332
Mailing Address - Fax:888-863-1824
Practice Address - Street 1:1207 E 50TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4023
Practice Address - Country:US
Practice Address - Phone:912-201-3332
Practice Address - Fax:888-863-1824
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA700134024BMedicaid
GA01261735OtherAMERIGROUP