Provider Demographics
NPI:1487915161
Name:WOOTEN, KIMBERLY S (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:S
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 W SPRINGMILL DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8909
Mailing Address - Country:US
Mailing Address - Phone:502-428-1781
Mailing Address - Fax:
Practice Address - Street 1:184 W SPRINGMILL DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8909
Practice Address - Country:US
Practice Address - Phone:502-428-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist