Provider Demographics
NPI:1073745469
Name:KERNER, DENYCE GIRARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENYCE
Middle Name:GIRARD
Last Name:KERNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 PLACID WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1294
Mailing Address - Country:US
Mailing Address - Phone:734-769-4867
Mailing Address - Fax:
Practice Address - Street 1:SJMH REICHERT HEALTH CENTER 5333 MCAULEY DR.
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-2745
Practice Address - Fax:734-712-8678
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006499103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist