Provider Demographics
NPI:1063564417
Name:MCDILL, KERRI S (AUD CCC-A)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:S
Last Name:MCDILL
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FENWAY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3053
Mailing Address - Country:US
Mailing Address - Phone:307-266-4100
Mailing Address - Fax:307-266-4106
Practice Address - Street 1:301 S FENWAY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3051
Practice Address - Country:US
Practice Address - Phone:307-266-4100
Practice Address - Fax:307-266-4106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-928231HA2400X, 237600000X, 237700000X, 231HA2500X
WYA928231H00000X, 235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY306079Medicaid