Provider Demographics
NPI:1821520180
Name:ISLEY, KERILYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERILYN
Middle Name:
Last Name:ISLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KERILYN
Other - Middle Name:MICHELLE
Other - Last Name:CLAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3505 JONWARN CT
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7117
Mailing Address - Country:US
Mailing Address - Phone:804-677-7026
Mailing Address - Fax:
Practice Address - Street 1:3505 JONWARN CT
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7117
Practice Address - Country:US
Practice Address - Phone:804-677-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist