Provider Demographics
NPI:1215094289
Name:KERSHAW, KRISTEN ERICA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ERICA
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 HENDERSONVILLE RD STE 17
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1956
Mailing Address - Country:US
Mailing Address - Phone:828-275-2493
Mailing Address - Fax:828-505-8860
Practice Address - Street 1:1293 HENDERSONVILLE RD STE 17
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1956
Practice Address - Country:US
Practice Address - Phone:828-275-2493
Practice Address - Fax:828-505-8860
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
141U2OtherBLUECROSS
186328OtherMEDCOST
NC7412464Medicaid