Provider Demographics
NPI:1215191101
Name:NUTT, KENDALL RAY (MA, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:KENDALL
Middle Name:RAY
Last Name:NUTT
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 UNIVERSITY PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9421
Mailing Address - Country:US
Mailing Address - Phone:850-476-1502
Mailing Address - Fax:850-476-1503
Practice Address - Street 1:9013 UNIVERSITY PKWY STE E
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9421
Practice Address - Country:US
Practice Address - Phone:850-476-1502
Practice Address - Fax:850-476-1503
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY977231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist