Healthcare Provider Details

I. General information

NPI: 1720538762
Provider Name (Legal Business Name): KERRA HANKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15751 E 1ST AVE
AURORA CO
80011-9023
US

IV. Provider business mailing address

15751 E 1ST AVE
AURORA CO
80011-9023
US

V. Phone/Fax

Practice location:
  • Phone: 732-556-7597
  • Fax:
Mailing address:
  • Phone: 732-556-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24554557
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: