Provider Demographics
NPI:1538571567
Name:KENNEDY, KAREN (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 BRAZOS DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4249
Mailing Address - Country:US
Mailing Address - Phone:817-925-3076
Mailing Address - Fax:
Practice Address - Street 1:1224 BRAZOS DR
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-4249
Practice Address - Country:US
Practice Address - Phone:817-925-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14551OtherSTATE BOARD OF EXAMINERS FOR SLP