Provider Demographics
NPI:1598324543
Name:HUBBARD, KERRI JEAN (MS-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:JEAN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:JEAN
Other - Last Name:WEGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 JONELL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5030
Mailing Address - Country:US
Mailing Address - Phone:518-522-4492
Mailing Address - Fax:
Practice Address - Street 1:4235 HILLSBORO PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3344
Practice Address - Country:US
Practice Address - Phone:615-200-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist