Provider Demographics
NPI:1043334253
Name:MAAS, KERI (AUD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:MAAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:PETROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6066 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2904
Mailing Address - Country:US
Mailing Address - Phone:708-687-4974
Mailing Address - Fax:708-687-4975
Practice Address - Street 1:6066 159TH ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-687-4974
Practice Address - Fax:708-687-4975
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000759231H00000X
IL14700759237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209747Medicare ID - Type Unspecified
387460Medicare UPIN
K09360Medicare UPIN
IL930640Medicare ID - Type Unspecified