Provider Demographics
NPI:1427293679
Name:DOTO, KIMBERLY ELLEN (MA, CCC-SLP/LIS)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:DOTO
Suffix:
Gender:F
Credentials:MA, CCC-SLP/LIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W SENECA ST
Mailing Address - Street 2:APT 18E
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2381
Mailing Address - Country:US
Mailing Address - Phone:315-247-4872
Mailing Address - Fax:
Practice Address - Street 1:3049 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1644
Practice Address - Country:US
Practice Address - Phone:315-445-4010
Practice Address - Fax:315-445-4060
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016615-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist