Provider Demographics
NPI:1255121786
Name:CARPENTER, KERRY JACOBS (CF-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:JACOBS
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2171
Mailing Address - Country:US
Mailing Address - Phone:304-282-4858
Mailing Address - Fax:
Practice Address - Street 1:1315 AIRPORT BLVD BLDG 4
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2927
Practice Address - Country:US
Practice Address - Phone:304-413-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist