Provider Demographics
NPI:1376732537
Name:HURLEY, KERRY KATHLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:KATHLEEN
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 WHITMORE LAKE RD.
Mailing Address - Street 2:SUITE I-M
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189
Mailing Address - Country:US
Mailing Address - Phone:630-220-8345
Mailing Address - Fax:
Practice Address - Street 1:11930 WHITMORE LAKE RD.
Practice Address - Street 2:SUITE I-M
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:734-449-4669
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist