Healthcare Provider Details

I. General information

NPI: 1780122341
Provider Name (Legal Business Name): KERRI KERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BRIELLE RD
NORTH GRAFTON MA
01536-1166
US

IV. Provider business mailing address

11 BRIELLE RD
NORTH GRAFTON MA
01536-1166
US

V. Phone/Fax

Practice location:
  • Phone: 508-887-6718
  • Fax:
Mailing address:
  • Phone: 508-887-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8241
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: