Kimberley B Green, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202003947 Issued in VA

Practice address

100 N Main St
Suffolk, VA 23434

Phone

(757) 925-6764

NPI assigned

Sep 27, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Kimberley Butler Former name

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Enrollment records 2

Specialty

Qualified Speech Language Pathologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Comprehensive Therapeutics LTDGroup PAC ID 8921230137, 324 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Comprehensive Therapeutics LTD

  • Physical Therapist
  • North Riverside, IL
  • NPI 1699094102

  DC, Speech-Language Pathologist, VA

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services, Inc

  dba Legacy Healthcare @ Grand Oaks

  • Physical Therapist
  • Washington, DC
  • NPI 1255750030

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• Comprehensive Therapeutics LTD

  • Physical Therapist
  • Lagrange, GA
  • NPI 1881458354

  Speech-Language Pathologist

  NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Speech-Language Pathologist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1235448119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344529",
            "telephone_number": "757-925-6764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "23434",
            "telephone_number": "757-925-6764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4016 Raintree Rd",
            "address_2": "Suite 240",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233213700",
            "country_code": "US",
            "telephone_number": "757-488-2864",
            "fax_number": "757-488-4735",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 N Main St",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "23434",
            "country_code": "US",
            "telephone_number": "757-925-6764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KIMBERLEY",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-27",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202003947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004979061",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLEY",
            "last_name": "BUTLER",
            "prefix": "MS.",
            "credential": "MS, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Greater Suffolk Medical Center
• Greater Transitions Counseling Services LLC
• Greater Visions Community Support Services, LLC.
• Dallis. Louis Green, M.D.
• Kenya Green, RBT
• Kitisha Green
• Greenbrook TMS Suffolk LLC
• Kelly Greenholtz
• Caitlin Greer, AU.D
• Douglas Blair Gregory, MD

• Speech-Language Pathologist in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.