Kimberly Joy McKillop, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

61168762 Issued in WA

Practice address

13400 NE 9TH St
Vancouver, WA 98684

Phone

(360) 604-6720

Fax

(360) 604-6722

NPI assigned

Sep 9, 2021

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 names 1

• Kimberly Joy Stout Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1356010763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 NW 24TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986656225",
            "telephone_number": "208-585-7336",
            "fax_number": "360-604-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 NE 9TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98684",
            "telephone_number": "360-604-6720",
            "fax_number": "360-604-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKILLOP",
        "first_name": "KIMBERLY",
        "middle_name": "JOY",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "61168762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "STOUT",
            "middle_name": "JOY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Loriann McKellar, D.C.
• Valarie L McKenna Ringer, LMHC
• Brittany McKenna
• Caroline J McKenna, LCSW
• Carmen McKibben
• Alexander McKimson, LMP
• Diane Cari McKinley, LMP
• Heidi Louise McKinney, MMFT
• Austin McKittrick, MS
• Gary G McLachlan, LMP

• Speech-Language Pathologist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.