Kimberly Richardson Gutierrez, M.A., CCC/SLP
Individual provider Active NPI Speech-Language Pathologist · Victor, ID
NPI 1295046670 · NPPES record last updated Jun 30, 2010
Key facts
- NPI
- 1295046670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP-1143 (ID)
- Practice address
- 73 N Main St
Suite 3
Victor, ID 83455 - Phone
- (208) 201-5621
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-1143 | ID | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-1143 | ID | Yes |
Addresses
Primary practice location
73 N Main St
Suite 3
Victor, ID 83455
Mailing address
1371 E 4000 N
Driggs, ID 83422-5149
Phone (208) 201-5621
Other providers in Victor, ID
- James K Davis
- Devin Delaney
- Sidney Fleecs
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- Olivia Handyside
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- Carlen Williams Hervig
- Amy Herzog
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All providers in Victor, ID · Speech-Language Pathologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.