Provider Demographics
NPI:1508325119
Name:KARLAS, KERRI M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:KARLAS
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 1:5014 RIVERPORT CMNS APT A
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1458
Mailing Address - Country:US
Mailing Address - Phone:618-973-1150
Mailing Address - Fax:
Practice Address - Street 1:3900 STEARNS AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4154
Practice Address - Country:US
Practice Address - Phone:618-973-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE