Provider Demographics
NPI:1740764174
Name:REXROTH-KENNEDY, DONNA LOUISE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:REXROTH-KENNEDY
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 1:20 UNION ST NW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2204
Mailing Address - Country:US
Mailing Address - Phone:571-252-2188
Mailing Address - Fax:
Practice Address - Street 1:20 UNION ST NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2204
Practice Address - Country:US
Practice Address - Phone:571-252-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist