Provider Demographics
NPI:1699803817
Name:RICHMAN, KERRY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:RICHMAN
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 1:1620 BATSON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0062
Mailing Address - Country:US
Mailing Address - Phone:704-578-3023
Mailing Address - Fax:
Practice Address - Street 1:7301 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8251
Practice Address - Country:US
Practice Address - Phone:704-540-3777
Practice Address - Fax:704-540-1443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12889OtherBLUECROSSBLUESHIELD
NC7648723OtherAETNA