Provider Demographics
NPI:1023231388
Name:KIRIN, KIMBERLY (MS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KIRIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 OLD GREENSBORO RD
Mailing Address - Street 2:APT 3101
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8809
Mailing Address - Country:US
Mailing Address - Phone:205-393-6907
Mailing Address - Fax:
Practice Address - Street 1:8816 OLD GREENSBORO RD
Practice Address - Street 2:APT 3101
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8809
Practice Address - Country:US
Practice Address - Phone:205-393-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05183235Z00000X
AL2776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05183OtherLICENSE #