Provider Demographics
NPI:1013183862
Name:SCAMMERHORN, KERBE MAY (MS, CCC - SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERBE
Middle Name:MAY
Last Name:SCAMMERHORN
Suffix:
Gender:F
Credentials:MS, CCC - SLP
Other - Prefix:MISS
Other - First Name:KERBE
Other - Middle Name:LANE
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC - SLP
Mailing Address - Street 1:210 MANOR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364
Mailing Address - Country:US
Mailing Address - Phone:870-739-1600
Mailing Address - Fax:870-739-1605
Practice Address - Street 1:407 CARSON ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6852
Practice Address - Country:US
Practice Address - Phone:501-624-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167299721Medicaid