Provider Demographics
NPI:1285831388
Name:SARGENT, KENNETH J (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:SARGENT
Suffix:
Gender:M
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 1:43 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9203
Mailing Address - Country:US
Mailing Address - Phone:315-255-6143
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 ROUTE 90
Practice Address - Street 2:MANDEL THERAPY GROUP
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005172-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist