Provider Demographics
NPI:1366584575
Name:HINGST, KAISHA KIM (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KAISHA
Middle Name:KIM
Last Name:HINGST
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 W LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4475
Mailing Address - Country:US
Mailing Address - Phone:480-600-5622
Mailing Address - Fax:
Practice Address - Street 1:771 W LOCUST DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4475
Practice Address - Country:US
Practice Address - Phone:480-600-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955081Medicaid