Provider Demographics
NPI:1407900814
Name:KIMBERLEY GLISE, M.S. CCC-SLP
Entity type:Organization
Organization Name:KIMBERLEY GLISE, M.S. CCC-SLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GLISE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:702-461-1353
Mailing Address - Street 1:2373 VIEWCREST RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3156
Mailing Address - Country:US
Mailing Address - Phone:702-461-1353
Mailing Address - Fax:702-549-2608
Practice Address - Street 1:4600 E SUNSET RD
Practice Address - Street 2:SUITE 179
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2202
Practice Address - Country:US
Practice Address - Phone:702-461-5661
Practice Address - Fax:702-549-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV SP-797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty