Provider Demographics
NPI:1417796095
Name:MIKSCH, KERRIE (MSED CF-SLP)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:MIKSCH
Suffix:
Gender:F
Credentials:MSED CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2427
Mailing Address - Country:US
Mailing Address - Phone:518-361-3503
Mailing Address - Fax:
Practice Address - Street 1:12 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1734
Practice Address - Country:US
Practice Address - Phone:518-361-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist