Provider Demographics
NPI:1962655688
Name:ROSENBERG, KIMBERLY SARAH (MSED/CCC-SLP/L)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SARAH
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MSED/CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CRESTHILL AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-7108
Mailing Address - Country:US
Mailing Address - Phone:585-813-4840
Mailing Address - Fax:
Practice Address - Street 1:2049 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1823
Practice Address - Country:US
Practice Address - Phone:716-901-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016330-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist