Provider Demographics
NPI:1013488956
Name:KENNON WOODYARD, ALYSON K (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:K
Last Name:KENNON WOODYARD
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 1:100 PINNACLE CT APT 404
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6307
Mailing Address - Country:US
Mailing Address - Phone:606-407-3171
Mailing Address - Fax:
Practice Address - Street 1:1871 MIDLAND TRL
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9111
Practice Address - Country:US
Practice Address - Phone:502-633-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty