Provider Demographics
NPI:1073131108
Name:KENNEY, JULIA BROOKE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:BROOKE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 LEMMON AVE APT 5102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1877
Mailing Address - Country:US
Mailing Address - Phone:501-317-0358
Mailing Address - Fax:
Practice Address - Street 1:3223 LEMMON AVE APT 5102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1877
Practice Address - Country:US
Practice Address - Phone:501-317-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist