Basic Information
| Provider Information | |||||||||
| NPI: | 1376732537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURLEY | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11930 WHITMORE LAKE RD. | ||||||||
| Address2: | SUITE I-M | ||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302208345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11930 WHITMORE LAKE RD. | ||||||||
| Address2: | SUITE I-M | ||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344494649 | ||||||||
| FaxNumber: | 7344494669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146009092 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.