Provider Demographics
NPI:1144815432
Name:KENNEDY-DYGAS, MARGARET ANN (SLP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:KENNEDY-DYGAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780-1086
Mailing Address - Country:US
Mailing Address - Phone:337-504-9241
Mailing Address - Fax:
Practice Address - Street 1:1338 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1369
Practice Address - Country:US
Practice Address - Phone:740-373-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20191184-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist