Provider Demographics
NPI:1083119150
Name:NENNI, KERRY DALY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DALY
Last Name:NENNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6411
Mailing Address - Country:US
Mailing Address - Phone:540-658-6790
Mailing Address - Fax:
Practice Address - Street 1:2125 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6411
Practice Address - Country:US
Practice Address - Phone:540-658-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist