Provider Demographics
NPI:1578662193
Name:CANNADY, JENNIFER M (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:M
Last Name:CANNADY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:RISMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-841-1107
Mailing Address - Fax:785-841-1173
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-841-1107
Practice Address - Fax:785-841-1173
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS046316Medicare ID - Type Unspecified