Provider Demographics
NPI:1821767112
Name:KERNAGHAN AND MOORE: SPEECH AND LANGUAGE THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:KERNAGHAN AND MOORE: SPEECH AND LANGUAGE THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:KERNAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-376-1111
Mailing Address - Street 1:6245 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6006
Mailing Address - Country:US
Mailing Address - Phone:727-376-1111
Mailing Address - Fax:727-376-1113
Practice Address - Street 1:5741 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3453
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:727-376-1113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERNAGHAN AND MOORE SPEECH AND LANGUAGE THERAPY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108019000Medicaid