Provider Demographics
NPI:1962407270
Name:GILL, KIMBERLY (AUD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:8897 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6211
Mailing Address - Country:US
Mailing Address - Phone:404-205-8848
Mailing Address - Fax:440-205-9818
Practice Address - Street 1:8897 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6211
Practice Address - Country:US
Practice Address - Phone:440-205-8848
Practice Address - Fax:440-205-8848
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01033237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GI 4152611Medicare ID - Type Unspecified
Q37373Medicare UPIN