Provider Demographics
NPI:1508739210
Name:DZIUBA, KIMBERLY DANETTE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANETTE
Last Name:DZIUBA
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 1:7312 CHARTWELL RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-1707
Mailing Address - Country:US
Mailing Address - Phone:865-765-1648
Mailing Address - Fax:
Practice Address - Street 1:7312 CHARTWELL RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-1707
Practice Address - Country:US
Practice Address - Phone:865-765-1648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist