Active NPI
Kim Annette Dettman, MS CCC-SLP
- Speech-Language Pathologist
- Palm Harbor, FL
National Provider Identifier
1386989291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA2613
- Practice address
- 2600 Highlands Blvd N
Palm Harbor, FL 34684-2114 - Phone
- (727) 785-5671
- NPI assigned
- Dec 4, 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 | SA2613 | FL | Primary |
Addresses
Primary practice location
2600 Highlands Blvd N
Palm Harbor, FL 34684-2114
Mailing address
4922 Cambridge Blvd #201
Palm Harbor, FL 34685
Phone (727) 543-2738
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 |
|---|---|---|---|
| SA2613 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354579200000",
"number": "1386989291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4922 CAMBRIDGE BLVD #201",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "34685",
"telephone_number": "727-543-2738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 HIGHLANDS BLVD N",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346842114",
"telephone_number": "727-785-5671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTMAN",
"first_name": "KIM",
"middle_name": "ANNETTE",
"name_prefix": "Ms.",
"credential": "MS CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-04",
"last_updated": "2012-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA2613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Harbor, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.