Provider Demographics
NPI:1942530365
Name:KENNY, CASEY R (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:R
Last Name:KENNY
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 39TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8045
Mailing Address - Country:US
Mailing Address - Phone:308-698-2820
Mailing Address - Fax:308-698-2822
Practice Address - Street 1:615 W 39TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8045
Practice Address - Country:US
Practice Address - Phone:308-698-2820
Practice Address - Fax:308-698-2822
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025521900Medicaid