Provider Demographics
NPI:1154494037
Name:KERR, CAROLINE J (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:J
Last Name:KERR
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 YELLOWSTONE AVE
Mailing Address - Street 2:PINE RIDGE MALL
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2345
Mailing Address - Country:US
Mailing Address - Phone:208-238-0020
Mailing Address - Fax:208-238-0021
Practice Address - Street 1:4155 YELLOWSTONE AVE
Practice Address - Street 2:PINE RIDGE MALL
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-2345
Practice Address - Country:US
Practice Address - Phone:208-238-0020
Practice Address - Fax:208-238-0021
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD1215237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150424OtherBLUE SHIELD OF ID
IDAU373OtherBLUE CROSS OF ID
ID000010137942OtherREGENCE BCBS
ID000010150424OtherBLUE SHIELD OF ID