Provider Demographics
NPI:1679705800
Name:KIMES, PATRICIA J (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:KIMES
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-4617
Mailing Address - Country:US
Mailing Address - Phone:210-434-6711
Mailing Address - Fax:210-434-9360
Practice Address - Street 1:411 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4617
Practice Address - Country:US
Practice Address - Phone:210-434-6711
Practice Address - Fax:210-434-9360
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist