Provider Demographics
NPI:1871715706
Name:LENIUS, KERRY LEE (MS)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:LEE
Last Name:LENIUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:2ND FL DENTAL TOWER
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-273-6164
Mailing Address - Fax:352-392-7018
Practice Address - Street 1:1600 S.W. ARCHER ROAD
Practice Address - Street 2:2ND FLOOR, DENTAL TOWER
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0174
Practice Address - Country:US
Practice Address - Phone:352-273-5289
Practice Address - Fax:352-856-1565
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist