Provider Demographics
NPI:1144434960
Name:MICK, KERI ANNETTE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANNETTE
Last Name:MICK
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 1:809 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-1487
Mailing Address - Country:US
Mailing Address - Phone:316-283-3994
Mailing Address - Fax:
Practice Address - Street 1:NEWTON PRESBYTERIAN MANOR
Practice Address - Street 2:7TH STREET
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-284-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist