Provider Demographics
NPI:1982007233
Name:KENNEDY, REBECCA MARIE (HAS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1888 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-286-3186
Practice Address - Street 1:3409 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4807
Practice Address - Country:US
Practice Address - Phone:863-646-6663
Practice Address - Fax:863-709-9065
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST366237700000X
FLAS5093237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist