Provider Demographics
NPI:1073757449
Name:KENNEY, JENNIFER J (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:KENNEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1704
Mailing Address - Country:US
Mailing Address - Phone:518-641-8602
Mailing Address - Fax:
Practice Address - Street 1:34 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1704
Practice Address - Country:US
Practice Address - Phone:518-641-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20081235Z00000X
NY013145-1235Z00000X
NC9426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist