Provider Demographics
NPI:1962750083
Name:BICKEL, KIMBERLY L
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:BICKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SPRINGFIELD AVE
Mailing Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1755
Mailing Address - Country:US
Mailing Address - Phone:636-583-8626
Mailing Address - Fax:636-583-2403
Practice Address - Street 1:110 W SPRINGFIELD AVE
Practice Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1755
Practice Address - Country:US
Practice Address - Phone:636-583-8626
Practice Address - Fax:636-583-2403
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist