Provider Demographics
NPI:1770841884
Name:ZADIK, KERI LYNN (MS)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:ZADIK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:KERI
Other - Middle Name:LYNN
Other - Last Name:CREAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:534 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3113
Mailing Address - Country:US
Mailing Address - Phone:631-884-2869
Mailing Address - Fax:
Practice Address - Street 1:534 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3113
Practice Address - Country:US
Practice Address - Phone:631-884-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist