Provider Demographics
NPI:1881306918
Name:KERR, LAURA G
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:213-332-4172
Mailing Address - Fax:
Practice Address - Street 1:1045 W. REDONDO BEACH BLVD
Practice Address - Street 2:GARDENA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90247-9024
Practice Address - Country:US
Practice Address - Phone:213-332-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAMPSS-KYHOIN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker