Provider Demographics
NPI:1669409538
Name:KERRISH, MARIE LYN (MS/CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:LYN
Last Name:KERRISH
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCHWITTER AVENUE
Mailing Address - Street 2:APARTMENT 215
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229
Mailing Address - Country:US
Mailing Address - Phone:412-952-6924
Mailing Address - Fax:
Practice Address - Street 1:35 N BALPH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3200
Practice Address - Country:US
Practice Address - Phone:412-761-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist