Provider Demographics
NPI:1982840716
Name:KENNINGTON, KODY D (AUD)
Entity Type:Individual
Prefix:MR
First Name:KODY
Middle Name:D
Last Name:KENNINGTON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 W 7850 S
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:UT
Mailing Address - Zip Code:84340-6701
Mailing Address - Country:US
Mailing Address - Phone:435-734-9197
Mailing Address - Fax:
Practice Address - Street 1:1100 COUNTRY HILLS DR
Practice Address - Street 2:200
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2503
Practice Address - Country:US
Practice Address - Phone:801-399-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5159751-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1982840716Medicaid
UTU000076128Medicare UPIN