Provider Demographics
NPI:1962963868
Name:MARRS, KIMBERLY (MS SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:MARRS
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2215
Mailing Address - Country:US
Mailing Address - Phone:916-453-2262
Mailing Address - Fax:
Practice Address - Street 1:2425 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP34103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist