Provider Demographics
NPI:1962645358
Name:SEAVER, KIMBERLY LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SEAVER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:BONADONNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 SUNNINGDALE RISE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1601
Mailing Address - Country:US
Mailing Address - Phone:585-507-0336
Mailing Address - Fax:
Practice Address - Street 1:313 SUNNINGDALE RISE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1601
Practice Address - Country:US
Practice Address - Phone:585-507-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019012-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist