Provider Demographics
NPI:1346352937
Name:JAMES, KERI SUE (M A, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:SUE
Last Name:JAMES
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SUNNY HTS
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4605
Mailing Address - Country:US
Mailing Address - Phone:208-522-0191
Mailing Address - Fax:
Practice Address - Street 1:1619 CURLEW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4719
Practice Address - Country:US
Practice Address - Phone:208-535-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist