Provider Demographics
NPI:1568982072
Name:MCNAMARA, KERRY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCNAMARA
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 1:39 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-1908
Mailing Address - Country:US
Mailing Address - Phone:518-698-6552
Mailing Address - Fax:
Practice Address - Street 1:1744 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204
Practice Address - Country:US
Practice Address - Phone:315-468-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist