Provider Demographics
NPI:1578781241
Name:KERLEY, KATHRYNE WOLFE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:WOLFE
Last Name:KERLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N HOLTZCLAW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1240
Mailing Address - Country:US
Mailing Address - Phone:423-622-6900
Mailing Address - Fax:
Practice Address - Street 1:600 N HOLTZCLAW AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1240
Practice Address - Country:US
Practice Address - Phone:423-622-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4640001OtherUNITED HEALTHCARE
TN4143131OtherBLUECROSS BLUESHIELD TN