Provider Demographics
NPI:1548789514
Name:NULMAN, KERRY DORRIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:DORRIAN
Last Name:NULMAN
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 1:9 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3108
Mailing Address - Country:US
Mailing Address - Phone:609-306-0844
Mailing Address - Fax:
Practice Address - Street 1:9 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-3108
Practice Address - Country:US
Practice Address - Phone:609-306-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006330L235Z00000X
NJ41YS00393400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL006330LOtherSPEECH LANGUAGE PATHOLOGY LICENSE
NJ41YS00393400OtherSPEECH LANGUAGE PATHOLOGY LICENSE