Active NPI
Kimberly Kay Gomersall, M.S., CCC-SLP
- Speech-Language Pathologist
- Redmond, WA
National Provider Identifier
1306190236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL60228375
- Practice address
- 22845 NE Cedar Park Cres
Redmond, WA 98053-5887 - Phone
- (808) 561-2320
- NPI assigned
- Oct 30, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | LL60228375 | WA | Primary |
Addresses
Primary practice location
22845 NE Cedar Park Cres
Redmond, WA 98053-5887
Mailing address
22845 N.E. Cedar Park Crescent
Redmond, WA 98053
Phone (808) 561-2320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LL60228375 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL60228375 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1306190236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22845 N.E. CEDAR PARK CRESCENT",
"city": "REDMOND",
"state": "WA",
"postal_code": "98053",
"telephone_number": "808-561-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22845 NE CEDAR PARK CRES",
"city": "REDMOND",
"state": "WA",
"postal_code": "980535887",
"telephone_number": "808-561-2320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMERSALL",
"first_name": "KIMBERLY",
"middle_name": "KAY",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-30",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL60228375",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LL60228375",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redmond, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.