Provider Demographics
NPI:1174184329
Name:MONGE, KIMBERLY NMN (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NMN
Last Name:MONGE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MONGE
Other - Last Name:FERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:2321 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2113
Mailing Address - Country:US
Mailing Address - Phone:434-947-3993
Mailing Address - Fax:434-847-2941
Practice Address - Street 1:2321 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2113
Practice Address - Country:US
Practice Address - Phone:434-947-3993
Practice Address - Fax:434-847-2941
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist