Provider Demographics
NPI:1538548821
Name:LESTER, KIMBERLY BROOKE (MS, CCC--SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BROOKE
Last Name:LESTER
Suffix:
Gender:F
Credentials:MS, CCC--SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S DRURY ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-8223
Mailing Address - Country:US
Mailing Address - Phone:405-707-5267
Mailing Address - Fax:
Practice Address - Street 1:400 S DRURY ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-8223
Practice Address - Country:US
Practice Address - Phone:405-707-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist