Provider Demographics
NPI:1508528456
Name:BLOCKER, KENYA MONEICE
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:MONEICE
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EXECUTIVE PARK DR NE APT 3409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2277
Mailing Address - Country:US
Mailing Address - Phone:305-849-0563
Mailing Address - Fax:
Practice Address - Street 1:7 EXECUTIVE PARK DR NE APT 3409
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2277
Practice Address - Country:US
Practice Address - Phone:305-849-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist