Basic Information
| Provider Information | |||||||||
| NPI: | 1740872829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYMES | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42804 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863232957 | ||||||||
| FaxNumber: | 5863230022 | ||||||||
| Practice Location | |||||||||
| Address1: | 42804 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863232957 | ||||||||
| FaxNumber: | 5863230022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2021 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101007158 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 7101006276 | MI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.