Provider Demographics
NPI:1396926564
Name:KERCKHOFF, JESSICA A (AUD)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:KERCKHOFF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1243
Mailing Address - Country:US
Mailing Address - Phone:314-968-4710
Mailing Address - Fax:314-968-4762
Practice Address - Street 1:9835 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1243
Practice Address - Country:US
Practice Address - Phone:314-968-4710
Practice Address - Fax:314-968-4762
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004895231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist