Healthcare Provider Details

I. General information

NPI: 1750413308
Provider Name (Legal Business Name): KERRI EGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 GODDARD AVE
ORLANDO FL
32804-1168
US

IV. Provider business mailing address

3330 COLEUS CT
WINTER PARK FL
32792-2032
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-1533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: