1629148978 NPI number — KERRI C MONFALCONE M.A., CCC-SLP

Table of content: KERRI C MONFALCONE M.A., CCC-SLP (NPI 1629148978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629148978 NPI number — KERRI C MONFALCONE M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONFALCONE
Provider First Name:
KERRI
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629148978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 CREEKSIDE VILLAGE DR NW
Provider Second Line Business Mailing Address:
SUITE 603/604
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-2394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-974-2424
Provider Business Mailing Address Fax Number:
186-638-4645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 CREEKSIDE VILLAGE DR NW
Provider Second Line Business Practice Location Address:
SUITE 603/604
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-974-2424
Provider Business Practice Location Address Fax Number:
186-638-4645
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP007339 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7412266 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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