Provider Demographics
NPI:1013249127
Name:KIMERY, JENNIFER (MSR, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KIMERY
Suffix:
Gender:F
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3757
Mailing Address - Country:US
Mailing Address - Phone:949-220-3400
Mailing Address - Fax:
Practice Address - Street 1:2048 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3757
Practice Address - Country:US
Practice Address - Phone:949-220-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP39285OtherLICENSE
12063476OtherASHA
FLSA23216OtherLICENSE
OK4503OtherLICENSE