Provider Demographics
NPI:1366488637
Name:MCINTOSH, KERRI LYNNE (MSCCC/A)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LYNNE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MSCCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARGYLE SQUARE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-661-5111
Mailing Address - Fax:631-661-1959
Practice Address - Street 1:20 ARGYLE SQ
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2712
Practice Address - Country:US
Practice Address - Phone:631-661-5111
Practice Address - Fax:631-661-1959
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002038231H00000X
NY14000020174237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002038-1OtherREGISTRATION CERTIFICATE
NY14000020174OtherREGISTRATION CERTIFICATE