Provider Demographics
NPI:1558611343
Name:CUNNINGHAM, KERI BARLOW (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:BARLOW
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:115 S BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9655
Mailing Address - Country:US
Mailing Address - Phone:270-519-4712
Mailing Address - Fax:
Practice Address - Street 1:329 MADISON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0765
Practice Address - Country:US
Practice Address - Phone:270-519-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY140753235Z00000X
KY4127235Z00000X
MO2021034431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100342500Medicaid