Provider Demographics
NPI:1518635333
Name:ROSS-KENNEDY, ABBY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:ROSS-KENNEDY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:SUZANNE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 SHERRY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5233
Mailing Address - Country:US
Mailing Address - Phone:904-386-1012
Mailing Address - Fax:
Practice Address - Street 1:251 BREEZEWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3651
Practice Address - Country:US
Practice Address - Phone:904-386-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500799633Medicaid
FL113756300Medicaid