Provider Demographics
NPI:1548498967
Name:O'BRIEN, KIMBERLY GRACE (SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:GRACE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 MEADOW VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3910
Mailing Address - Country:US
Mailing Address - Phone:216-410-5134
Mailing Address - Fax:
Practice Address - Street 1:2821 WHIPPLE AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-6215
Practice Address - Country:US
Practice Address - Phone:330-478-1752
Practice Address - Fax:330-478-1763
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist