Provider Demographics
NPI:1417775511
Name:KIM, NATALIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 KEARNY AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032
Mailing Address - Country:US
Mailing Address - Phone:848-216-5026
Mailing Address - Fax:
Practice Address - Street 1:841 KEARNY AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032
Practice Address - Country:US
Practice Address - Phone:848-216-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01291400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist