Provider Demographics
NPI:1437221645
Name:KENNEDY-VOSU, LORRAINE AGNES (MA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:AGNES
Last Name:KENNEDY-VOSU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1602
Mailing Address - Country:US
Mailing Address - Phone:775-322-4327
Mailing Address - Fax:775-327-4227
Practice Address - Street 1:821 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1602
Practice Address - Country:US
Practice Address - Phone:775-322-4327
Practice Address - Fax:775-327-4227
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA153237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV642310OtherBLUE CROSS PROVIDER
NV642310OtherBLUE CROSS PROVIDER
NV38574Medicare ID - Type UnspecifiedPROVIDER NUMBER