Provider Demographics
NPI:1538353891
Name:PENDAK, KERRY L (AUD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:PENDAK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:L
Other - Last Name:GUDLEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - AUDIOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8125
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC - AUDIOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA543231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30436059Medicaid
VT1014076Medicaid
NH000295001Medicare PIN
NH000295002Medicare PIN