Provider Demographics
NPI:1265262307
Name:HAGGERTY, KERRY ANNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KERRY-ANNE
Other - Middle Name:
Other - Last Name:HAGGERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5656 CORPORATE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5656 CORPORATE AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4728
Practice Address - Country:US
Practice Address - Phone:714-828-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist