Tucker, Kimberly Jan
Tucker, Kimberly Jan is an individual health care provider with primary practice located at 10100 Groomsbridge Rd , Johns Creek GA 30022-2673. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Tucker, Kimberly Jan can be contacted via phone (770) 880-7684.Contact Information
Primary practice address
10100 Groomsbridge Rd
Johns Creek GA 30022-2673
Phone: (770) 880-7684
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | PCET001021 | Georgia |
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SLP00006300 | Georgia |
Profile Details
| NPI number | 1336131994 |
|---|---|
| LBN Legal business name | Tucker, Kimberly Jan |
| Credentials | M.ED., CCC-SLP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2005 |
| Last updated | May 6th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336131994 | NPPES |
| Georgia | MEDICAID | 637018452A | |
| Georgia | MEDICAID | 10033374 | |
| Georgia | Other | 52703821 002 |
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