Provider Demographics
NPI:1700981933
Name:MILLIGAN, KIMBERLY DIANE (MS-SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11523 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-4416
Mailing Address - Country:US
Mailing Address - Phone:618-435-4108
Mailing Address - Fax:618-438-5080
Practice Address - Street 1:11523 STATE HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-4416
Practice Address - Country:US
Practice Address - Phone:618-435-4108
Practice Address - Fax:618-438-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist