Provider Demographics
NPI:1417442815
Name:SHARPE, KERIANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERIANNE
Middle Name:
Last Name:SHARPE
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 1:29 CHILHOWIE DR
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-3201
Mailing Address - Country:US
Mailing Address - Phone:973-998-1766
Mailing Address - Fax:
Practice Address - Street 1:29 CHILHOWIE DR
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-3201
Practice Address - Country:US
Practice Address - Phone:973-998-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00923500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty