Provider Demographics
NPI:1730749623
Name:WHITEHOUSE, KIMBERLY MARIE (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WHITEHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5067 ELIZABETH ST N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5386
Mailing Address - Country:US
Mailing Address - Phone:503-602-8724
Mailing Address - Fax:
Practice Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1180
Practice Address - Country:US
Practice Address - Phone:503-926-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist