Provider Demographics
NPI:1952077265
Name:MERRICK, TRAVIS ANDREW (SLP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANDREW
Last Name:MERRICK
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2906
Mailing Address - Country:US
Mailing Address - Phone:845-702-3444
Mailing Address - Fax:
Practice Address - Street 1:36 BROOKS DR
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-2906
Practice Address - Country:US
Practice Address - Phone:845-702-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist