Kimberly G Kidder, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4834 Issued in LA

Practice address

1500 W Willow St
Scott, LA 70583-5303

Phone

(337) 521-7700

Fax

(337) 521-7701

NPI assigned

Mar 9, 2007

Last updated

May 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1366574204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 BELLE GROVE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70503",
            "telephone_number": "337-993-3417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W WILLOW ST",
            "city": "SCOTT",
            "state": "LA",
            "postal_code": "705835303",
            "telephone_number": "337-521-7700",
            "fax_number": "337-521-7701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Eula Dr",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705066048",
            "country_code": "US",
            "telephone_number": "337-578-1670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "KIMBERLY",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "4834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1478202",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Scott, LA
• Providers in Scott, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.