Provider Demographics
NPI:1083234157
Name:MCKEEVER, KERRY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCKEEVER
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 1:47 WINTERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3027
Mailing Address - Country:US
Mailing Address - Phone:845-325-2692
Mailing Address - Fax:
Practice Address - Street 1:121 DUNNING RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2243
Practice Address - Country:US
Practice Address - Phone:845-325-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist