Provider Demographics
NPI:1659962504
Name:KIRKPATRICK, KENNEDY ROAN
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:ROAN
Last Name:KIRKPATRICK
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 1:610 W BENDER BLVD STE 1300
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2241
Mailing Address - Country:US
Mailing Address - Phone:575-433-2002
Mailing Address - Fax:888-729-4956
Practice Address - Street 1:610 W BENDER BLVD STE 1300
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2241
Practice Address - Country:US
Practice Address - Phone:575-433-2002
Practice Address - Fax:888-729-4956
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMSLPA7325OtherSTATE SLPA LICENSE