Provider Demographics
NPI:1154728749
Name:VIPPERMAN, KERRI (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:VIPPERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRISTMILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2627
Mailing Address - Country:US
Mailing Address - Phone:434-385-1074
Mailing Address - Fax:434-385-1342
Practice Address - Street 1:305 GRISTMILL DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2627
Practice Address - Country:US
Practice Address - Phone:434-385-1074
Practice Address - Fax:434-385-1342
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist