Provider Demographics
NPI:1013098730
Name:KENNY, BETH (AUD)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 LAKE COLONY DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2340
Mailing Address - Country:US
Mailing Address - Phone:412-337-5170
Mailing Address - Fax:
Practice Address - Street 1:522 W NEWTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2820
Practice Address - Country:US
Practice Address - Phone:724-834-8113
Practice Address - Fax:724-832-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005881231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075114ZMFKMedicare PIN