Provider Demographics
NPI:1992451777
Name:OSAM, KIMBERLY GREGORY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GREGORY
Last Name:OSAM
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 HOOVER LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6770
Mailing Address - Country:US
Mailing Address - Phone:571-217-8124
Mailing Address - Fax:
Practice Address - Street 1:8020 RIVER STONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8761
Practice Address - Country:US
Practice Address - Phone:571-217-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist