Provider Demographics
NPI:1912333246
Name:KERCHAL, JESSIE M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:KERCHAL
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 1:74322 AVENUE 350
Mailing Address - Street 2:
Mailing Address - City:WAUNETA
Mailing Address - State:NE
Mailing Address - Zip Code:69045-7116
Mailing Address - Country:US
Mailing Address - Phone:308-350-0705
Mailing Address - Fax:
Practice Address - Street 1:130 N TECUMSEH
Practice Address - Street 2:
Practice Address - City:WAUNETA
Practice Address - State:NE
Practice Address - Zip Code:69045-9726
Practice Address - Country:US
Practice Address - Phone:308-394-5333
Practice Address - Fax:308-365-1927
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1912333246Medicaid