Provider Demographics
NPI:1073896593
Name:DELUCA, KERRY R (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:R
Last Name:DELUCA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-1234
Mailing Address - Country:US
Mailing Address - Phone:518-756-5200
Mailing Address - Fax:
Practice Address - Street 1:1146 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:SELKIRK
Practice Address - State:NY
Practice Address - Zip Code:12158-1800
Practice Address - Country:US
Practice Address - Phone:518-756-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008114-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist