Provider Demographics
NPI:1811666043
Name:WORTHAM, KERIN ELIZABETH (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:KERIN
Middle Name:ELIZABETH
Last Name:WORTHAM
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 1:401 E RICHMOND
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-8792
Mailing Address - Country:US
Mailing Address - Phone:903-356-1200
Mailing Address - Fax:
Practice Address - Street 1:401 E RICHMOND
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-8792
Practice Address - Country:US
Practice Address - Phone:903-356-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist