Provider Demographics
NPI:1710212345
Name:DUFF, KERIN ELISENS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERIN
Middle Name:ELISENS
Last Name:DUFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KERIN
Other - Middle Name:
Other - Last Name:ELISENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:33 HOMER ST
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-0084
Mailing Address - Country:US
Mailing Address - Phone:315-889-5836
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 STATE ROUTE 90
Practice Address - Street 2:
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist