Provider Demographics
NPI:1194015180
Name:KENNEDY, HEIDI (SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LACRUE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1062
Mailing Address - Country:US
Mailing Address - Phone:800-578-7906
Mailing Address - Fax:
Practice Address - Street 1:5039 E MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1944
Practice Address - Country:US
Practice Address - Phone:619-922-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist