Provider Demographics
NPI:1043831043
Name:POTTHOFF, KERRI (MS CCC-SLP CBIS)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:POTTHOFF
Suffix:
Gender:F
Credentials:MS CCC-SLP CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5114
Mailing Address - Country:US
Mailing Address - Phone:712-790-4664
Mailing Address - Fax:
Practice Address - Street 1:2085 BRYANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5114
Practice Address - Country:US
Practice Address - Phone:712-790-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist