Provider Demographics
NPI:1447232483
Name:KENNEDY, ELIZABETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 CLEMENTS BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007
Mailing Address - Country:US
Mailing Address - Phone:856-546-1535
Mailing Address - Fax:856-546-6565
Practice Address - Street 1:121 CLEMENTS BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007
Practice Address - Country:US
Practice Address - Phone:856-546-1535
Practice Address - Fax:856-546-6565
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00009600231H00000X
NJ25MG0004800237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
875776OtherHORIZON BCBSNJ
0991999000OtherAMERIHEALTH
1827761OtherCIGNA
557330OtherAETNA
NJ2975106Medicaid
462032OtherMULTIPLAN
P842947OtherOXFORD UNITED HEALTHCARE
0991999000OtherAMERIHEALTH