Provider Demographics
NPI:1093050957
Name:FOLSOM, KENNETH A (HAS, BC-HIS, ACA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:HAS, BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N. MONROE ST.
Mailing Address - Street 2:#3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:850-898-5633
Mailing Address - Fax:850-898-4994
Practice Address - Street 1:903 N MONROE ST
Practice Address - Street 2:#3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-878-5633
Practice Address - Fax:850-878-4994
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS972237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist