Active NPI
Kerri Mazur
- Speech-Language Pathologist
- Lake Ariel, PA
National Provider Identifier
1679981807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL004327L
- Practice address
- 1404 Golf Park Dr
Lake Ariel, PA 18436-4252 - Phone
- (570) 698-5647
- NPI assigned
- Jul 31, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL004327L | PA | Primary |
Addresses
Primary practice location
1404 Golf Park Dr
Lake Ariel, PA 18436-4252
Mailing address
1404 Golf Park Dr
Lake Ariel, PA 18436-4252
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101802 | Other | PA | FACILITY LICENSE # |
| 102602636-0001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL004327L | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1679981807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1404 GOLF PARK DR",
"city": "LAKE ARIEL",
"state": "PA",
"postal_code": "184364252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1404 GOLF PARK DR",
"city": "LAKE ARIEL",
"state": "PA",
"postal_code": "184364252",
"telephone_number": "570-698-5647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZUR",
"first_name": "KERRI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-31",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL004327L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FACILITY LICENSE #",
"identifier": "101802",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102602636-0001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Ariel, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.