Provider Demographics
NPI:1447349899
Name:KERN, CAROLYN ALICE (MS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ALICE
Last Name:KERN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ALICE
Other - Last Name:KERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:595 MILLICH DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0550
Mailing Address - Country:US
Mailing Address - Phone:408-379-0245
Mailing Address - Fax:408-379-0361
Practice Address - Street 1:595 MILLICH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0550
Practice Address - Country:US
Practice Address - Phone:408-379-0245
Practice Address - Fax:408-379-0361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist