Provider Demographics
NPI:1952363061
Name:HAVENS, KERRY MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MICHELLE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:MICHELLE
Other - Last Name:MENKEDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2825 BURNET AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2426
Mailing Address - Country:US
Mailing Address - Phone:513-221-0527
Mailing Address - Fax:513-221-8014
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-1703
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 01118231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH018250Medicare PIN
OH4177551Medicare PIN