MEDICARE: KERRI LYN MCDANIEL MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-84726	GA

General Provider Information

NPI Number	:	1639045115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI LYN MCDANIEL MA, BCBA

Provider Business Mailing Address
First Line	:	330 GILMER FERRY RD
Second Line	:
City	:	BALL GROUND
State	:	GA
Zip	:	30107-2909
Country	:	US
Telephone Number	:	413-526-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 HOLLY SPRINGS PKWY STE 101
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-2343
Country	:	US
Telephone Number	:	413-526-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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