Provider Demographics
NPI:1588702757
Name:HOSP, KERRY MELISSA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:MELISSA
Last Name:HOSP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10243 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2028
Mailing Address - Country:US
Mailing Address - Phone:414-604-2200
Mailing Address - Fax:
Practice Address - Street 1:10243 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2028
Practice Address - Country:US
Practice Address - Phone:414-604-2200
Practice Address - Fax:414-604-7200
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4113-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167867Medicaid