Provider Demographics
NPI:1538400411
Name:KENNY, JANIS (HIS)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 OAK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1723
Mailing Address - Country:US
Mailing Address - Phone:810-227-6514
Mailing Address - Fax:
Practice Address - Street 1:2544 HARTE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7002
Practice Address - Country:US
Practice Address - Phone:517-545-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004794237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist