Provider Demographics
NPI:1629148978
Name:MONFALCONE, KERRI C (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:C
Last Name:MONFALCONE
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 1:3105 CREEKSIDE VILLAGE DR NW
Mailing Address - Street 2:SUITE 603/604
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2394
Mailing Address - Country:US
Mailing Address - Phone:770-974-2424
Mailing Address - Fax:186-638-4645
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW
Practice Address - Street 2:SUITE 603/604
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2394
Practice Address - Country:US
Practice Address - Phone:770-974-2424
Practice Address - Fax:186-638-4645
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412266Medicaid