Provider Demographics
NPI:1396979373
Name:ROULA, KERI
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:
Last Name:ROULA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:COMMISSO-ROULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15915 88TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3037
Mailing Address - Country:US
Mailing Address - Phone:718-848-2700
Mailing Address - Fax:718-848-4226
Practice Address - Street 1:15915 88TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3037
Practice Address - Country:US
Practice Address - Phone:718-848-2700
Practice Address - Fax:718-848-4226
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist