Provider Demographics
NPI:1649476227
Name:STREATER, KIMBERLY ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ANN
Last Name:STREATER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2013
Mailing Address - Country:US
Mailing Address - Phone:856-264-6519
Mailing Address - Fax:
Practice Address - Street 1:5 EVES DR
Practice Address - Street 2:SUITE 160
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3135
Practice Address - Country:US
Practice Address - Phone:856-985-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00506800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist