Provider Demographics
NPI:1437598224
Name:STAAB, KERRI ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:STAAB
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ANNE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1191 CANYON VIEW PL
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:343 6TH ST
Practice Address - Street 2:UNIT L
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1784
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist