Provider Demographics
NPI:1902059140
Name:VENTIMIGLIA, KIM MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:VENTIMIGLIA
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:777 N BROADWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1000
Mailing Address - Country:US
Mailing Address - Phone:914-366-3010
Mailing Address - Fax:914-366-1359
Practice Address - Street 1:777 N BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1000
Practice Address - Country:US
Practice Address - Phone:914-366-3010
Practice Address - Fax:914-366-1359
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist