Provider Demographics
NPI:1144616202
Name:MEHRER, KIVONEY (HIS)
Entity Type:Individual
Prefix:MS
First Name:KIVONEY
Middle Name:
Last Name:MEHRER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MRS
Other - First Name:KIVONEY
Other - Middle Name:
Other - Last Name:WISDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:45 DOCS PLACE EXT
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6751
Mailing Address - Country:US
Mailing Address - Phone:302-251-8252
Mailing Address - Fax:
Practice Address - Street 1:32566 DOCS PL UNIT 2
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6959
Practice Address - Country:US
Practice Address - Phone:302-251-8252
Practice Address - Fax:856-320-2104
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00110700237700000X
PAF03257237700000X
DEO3-0010283237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist