Provider Demographics
NPI:1144405432
Name:CALLAHAN-MANDULAK, KERRY FRANCES (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:FRANCES
Last Name:CALLAHAN-MANDULAK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BAKER HOUSE TRENT DRIVE
Mailing Address - Street 2:DUMC 3887
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-668-4295
Mailing Address - Fax:919-668-4284
Practice Address - Street 1:155 BAKER HOUSE TRENT DRIVE
Practice Address - Street 2:DUMC 3887
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-668-4295
Practice Address - Fax:919-668-4284
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist