Provider Demographics
NPI:1609213214
Name:KENNEDY, QUENTIN P (AUD)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:P
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 AIRPORT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2020
Mailing Address - Country:US
Mailing Address - Phone:650-240-8198
Mailing Address - Fax:408-328-5695
Practice Address - Street 1:1501 TROUSDALE DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-652-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000768231H00000X
CAAUD2984231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist