Provider Demographics
NPI:1881792646
Name:FARMER, KERRY JOHANNA (MS CCC A)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JOHANNA
Last Name:FARMER
Suffix:
Gender:F
Credentials:MS CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SE MARLIN AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-861-3235
Mailing Address - Fax:503-861-3436
Practice Address - Street 1:429 SE MARLIN AVE
Practice Address - Street 2:UNIT A
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-861-3235
Practice Address - Fax:503-861-3436
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60254321231H00000X
OR30787231H00000X
CAAU2212231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU2212AMedicare ID - Type Unspecified