Provider Demographics
NPI:1144196437
Name:WAINSCOTT, KIMBERLY RENEA
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEA
Last Name:WAINSCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20025 E GERMANN RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9747
Mailing Address - Country:US
Mailing Address - Phone:480-265-5557
Mailing Address - Fax:
Practice Address - Street 1:20025 E GERMANN RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9747
Practice Address - Country:US
Practice Address - Phone:480-265-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ168032355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant