Provider Demographics
NPI:1114173317
Name:LOCASTRO, KERRI BAGGETT (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:BAGGETT
Last Name:LOCASTRO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 JOE WHEELER BROWN RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8943
Mailing Address - Country:US
Mailing Address - Phone:662-862-9487
Mailing Address - Fax:
Practice Address - Street 1:1958 JOE WHEELER BROWN RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8943
Practice Address - Country:US
Practice Address - Phone:662-862-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist