Provider Demographics
NPI:1740872829
Name:SYMES, KERRY (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:SYMES
Suffix:
Gender:F
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 1:42804 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1656
Mailing Address - Country:US
Mailing Address - Phone:586-323-2957
Mailing Address - Fax:586-323-0022
Practice Address - Street 1:42804 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1656
Practice Address - Country:US
Practice Address - Phone:586-323-2957
Practice Address - Fax:586-323-0022
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007158235Z00000X
MI7101006276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist