Provider Demographics
NPI:1023328846
Name:VASQUEZ, KERRI ELIZABETH (MA,CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ELIZABETH
Last Name:VASQUEZ
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 1:5503 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1836
Mailing Address - Country:US
Mailing Address - Phone:718-651-8641
Mailing Address - Fax:718-651-8641
Practice Address - Street 1:5503 68TH ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1836
Practice Address - Country:US
Practice Address - Phone:718-651-8641
Practice Address - Fax:718-651-8641
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008414-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist