Provider Demographics
NPI:1487061396
Name:KERZNER-WILSON, MARJORY
Entity type:Individual
Prefix:
First Name:MARJORY
Middle Name:
Last Name:KERZNER-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3018
Mailing Address - Country:US
Mailing Address - Phone:912-224-2112
Mailing Address - Fax:
Practice Address - Street 1:1000 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2601
Practice Address - Country:US
Practice Address - Phone:912-335-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA109758OtherGEORGIA EDUCATOR CERTIFICATE
GASLP009120OtherGA SLP LICENSE