Provider Demographics
NPI:1528527405
Name:KIM S. HAVARD, MS CCC-SLP LLC
Entity type:Organization
Organization Name:KIM S. HAVARD, MS CCC-SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:601-408-1365
Mailing Address - Street 1:98 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6008
Mailing Address - Country:US
Mailing Address - Phone:601-408-1365
Mailing Address - Fax:601-300-3015
Practice Address - Street 1:98 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6008
Practice Address - Country:US
Practice Address - Phone:601-408-1365
Practice Address - Fax:601-300-3015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIM S. HAVARD, MS CCC-SLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty