Provider Demographics
NPI:1851589949
Name:ROOT, KERRY M (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:M
Last Name:ROOT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:M
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:1440 LOBLOLLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548
Mailing Address - Country:US
Mailing Address - Phone:254-698-2407
Mailing Address - Fax:
Practice Address - Street 1:1440 LOBLOLLY DRIVE
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:254-698-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist