Provider Demographics
NPI:1649392960
Name:SMITH, KERENSA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERENSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3699 ALEXANDRIA PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1789
Mailing Address - Country:US
Mailing Address - Phone:859-572-0430
Mailing Address - Fax:
Practice Address - Street 1:3699 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1789
Practice Address - Country:US
Practice Address - Phone:859-572-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist