Provider Demographics
NPI:1427255082
Name:MILLICAN, KIMBERLY JOY (SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JOY
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:AL
Mailing Address - Zip Code:35552-2104
Mailing Address - Country:US
Mailing Address - Phone:205-712-0436
Mailing Address - Fax:205-695-0666
Practice Address - Street 1:245 CAHABA VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2217
Practice Address - Country:US
Practice Address - Phone:205-695-9313
Practice Address - Fax:205-695-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist