Provider Demographics
NPI:1134620404
Name:RESTAINO, KERRI MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:MARIE
Last Name:RESTAINO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:MARIE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:109 SAMUEL CT
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1407
Mailing Address - Country:US
Mailing Address - Phone:551-655-5269
Mailing Address - Fax:
Practice Address - Street 1:109 SAMUEL CT
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1407
Practice Address - Country:US
Practice Address - Phone:551-655-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00822100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14089258OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
NJ41YS00822100OtherOFFICE OF ATT. GENERAL, DIV. OF CONSUMER AFFAIRS, AUDIO. & SPEECH LANG PATH COM