Provider Demographics
NPI:1508169103
Name:OWEN, KENDALL MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:MARIE
Last Name:OWEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:KENDALL
Other - Middle Name:MARIE
Other - Last Name:CALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4515 LINDFORD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2940
Mailing Address - Country:US
Mailing Address - Phone:330-933-7945
Mailing Address - Fax:
Practice Address - Street 1:6057 STRIP AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-9207
Practice Address - Country:US
Practice Address - Phone:330-492-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND-2011165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055563Medicaid
OH366757Medicare PIN