Provider Demographics
NPI:1568637551
Name:POE, KERRY ROBERTS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ROBERTS
Last Name:POE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ROBERTS
Other - Last Name:POE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:9835 NORTHCROSS CENTER CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7346
Mailing Address - Country:US
Mailing Address - Phone:704-896-8688
Mailing Address - Fax:704-896-7975
Practice Address - Street 1:8924 NELLIE LN
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-7948
Practice Address - Country:US
Practice Address - Phone:704-896-8688
Practice Address - Fax:704-896-7975
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist