Provider Demographics
NPI:1972016764
Name:KENNEY, SARA JANE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:KENNEY
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 1:51-01 39TH AVE
Mailing Address - Street 2:APT GG21
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:347-537-8230
Mailing Address - Fax:
Practice Address - Street 1:51-01 39TH AVE
Practice Address - Street 2:APT GG21
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-350-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-04-12
Deactivation Date:2018-01-19
Deactivation Code:
Reactivation Date:2018-01-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist