Provider Demographics
NPI:1821706797
Name:KENNEDY, ADRIENNE (SLPA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MENA ST
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3339
Mailing Address - Country:US
Mailing Address - Phone:501-470-3500
Mailing Address - Fax:501-470-3502
Practice Address - Street 1:605 MENA ST
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-3339
Practice Address - Country:US
Practice Address - Phone:501-470-3500
Practice Address - Fax:501-470-3502
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant