Provider Demographics
NPI:1184096604
Name:KIERNAN, BARRY (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:M
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 1:3121 E EDGERTON RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3108
Mailing Address - Country:US
Mailing Address - Phone:440-522-0245
Mailing Address - Fax:
Practice Address - Street 1:3121 E EDGERTON RD
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:OH
Practice Address - Zip Code:44224-3108
Practice Address - Country:US
Practice Address - Phone:440-522-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist