Provider Demographics
NPI:1447515721
Name:AMEND, KERI E (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:E
Last Name:AMEND
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:WINCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:845-707-8857
Practice Address - Street 1:1 BOGEY LN
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:845-707-8857
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022035235Z00000X
NY022035-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist