Provider Demographics
NPI:1851544993
Name:GRIFFIN, KERRY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BARDOLIER LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7541
Mailing Address - Country:US
Mailing Address - Phone:631-553-8225
Mailing Address - Fax:
Practice Address - Street 1:62 BARDOLIER LN
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7541
Practice Address - Country:US
Practice Address - Phone:631-553-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist