Provider Demographics
NPI:1407240104
Name:KENNER, BRENDA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:KENNER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 W KRISTINA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-5454
Mailing Address - Country:US
Mailing Address - Phone:281-414-4216
Mailing Address - Fax:
Practice Address - Street 1:11440 W KRISTINA CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-5454
Practice Address - Country:US
Practice Address - Phone:281-414-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist