Provider Demographics
NPI:1609185149
Name:KAREN KERR SPEECH LANGUAGE PATHOLOGY LLC
Entity Type:Organization
Organization Name:KAREN KERR SPEECH LANGUAGE PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:718-578-8011
Mailing Address - Street 1:75 EDGEWOOD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1532
Mailing Address - Country:US
Mailing Address - Phone:718-578-8011
Mailing Address - Fax:516-944-8400
Practice Address - Street 1:295 CENTRAL PARK W
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3008
Practice Address - Country:US
Practice Address - Phone:718-578-8011
Practice Address - Fax:516-944-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty