Provider Demographics
NPI:1215241237
Name:BUCKMAN, KERRI LYNN (SPECED TEACHER)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:SPECED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-1402
Mailing Address - Country:US
Mailing Address - Phone:618-302-7794
Mailing Address - Fax:
Practice Address - Street 1:336 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1402
Practice Address - Country:US
Practice Address - Phone:618-302-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2140837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist