Provider Demographics
NPI:1497915912
Name:KERNS-BENTZ, NIKKI LEIGH
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEIGH
Last Name:KERNS-BENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LEIGH
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4281 S VARIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5896
Mailing Address - Country:US
Mailing Address - Phone:208-631-7699
Mailing Address - Fax:
Practice Address - Street 1:1833 S MILLENNIUM WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1510
Practice Address - Country:US
Practice Address - Phone:208-898-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist