Provider Demographics
NPI:1861649329
Name:KING, KERRI (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 1ST AVE
Mailing Address - Street 2:1-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9426
Mailing Address - Country:US
Mailing Address - Phone:917-754-1388
Mailing Address - Fax:212-358-0332
Practice Address - Street 1:41 1ST AVE
Practice Address - Street 2:1-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9426
Practice Address - Country:US
Practice Address - Phone:917-754-1388
Practice Address - Fax:212-358-0332
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist