Provider Demographics
NPI:1023425337
Name:KENNARD, RYAN (AUD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:KENNARD
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 1:1035 PEACH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2700
Mailing Address - Country:US
Mailing Address - Phone:805-476-6212
Mailing Address - Fax:805-269-8091
Practice Address - Street 1:1035 PEACH ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-476-6212
Practice Address - Fax:805-269-8091
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist