Provider Demographics
NPI:1871797035
Name:GRENOBLE, KIMBERLY LEONARD
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LEONARD
Last Name:GRENOBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BETHEL DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2809
Mailing Address - Country:US
Mailing Address - Phone:704-636-7250
Mailing Address - Fax:
Practice Address - Street 1:1505 BRINGLE FERRY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-4776
Practice Address - Country:US
Practice Address - Phone:704-637-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235Z00000XMedicare ID - Type UnspecifiedSPEECH