Provider Demographics
NPI:1144325424
Name:COHEN, KERRY ANN (AUD)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANN
Last Name:COHEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:WAGEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 CARLTON STREET
Mailing Address - Street 2:593 ADERHOLD HALL
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1526
Mailing Address - Country:US
Mailing Address - Phone:706-542-4598
Mailing Address - Fax:
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-383-6800
Practice Address - Fax:617-383-6801
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA835231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000022801Medicare PIN