Provider Demographics
NPI:1316821358
Name:MUNN, KIMBERLY (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MUNN
Suffix:
Gender:X
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1649
Mailing Address - Country:US
Mailing Address - Phone:734-649-7414
Mailing Address - Fax:
Practice Address - Street 1:1334 WOODLAND CT
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1649
Practice Address - Country:US
Practice Address - Phone:734-649-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist