Provider Demographics
NPI:1659481505
Name:MOUCH, KERRI OLIVIER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:OLIVIER
Last Name:MOUCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 RIVERINE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-5000
Mailing Address - Country:US
Mailing Address - Phone:225-205-1540
Mailing Address - Fax:
Practice Address - Street 1:6111 RIVERINE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-5000
Practice Address - Country:US
Practice Address - Phone:225-205-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist