Provider Demographics
NPI:1104029214
Name:KENNERKNECHT, ANNA C (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:KENNERKNECHT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CROCKER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1072
Mailing Address - Country:US
Mailing Address - Phone:440-438-3401
Mailing Address - Fax:440-999-8924
Practice Address - Street 1:815 CROCKER RD STE 8
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1072
Practice Address - Country:US
Practice Address - Phone:440-438-3401
Practice Address - Fax:440-999-8924
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310231H00000X, 237600000X
OHA.02285237600000X
MT6606237600000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83234551Medicaid