Provider Demographics
NPI:1134357908
Name:WARD, KINSEY BASS (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KINSEY
Middle Name:BASS
Last Name:WARD
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 1:147 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:NC
Mailing Address - Zip Code:27980-9600
Mailing Address - Country:US
Mailing Address - Phone:252-312-5455
Mailing Address - Fax:
Practice Address - Street 1:147 MEADOW RD
Practice Address - Street 2:
Practice Address - City:TYNER
Practice Address - State:NC
Practice Address - Zip Code:27980-9600
Practice Address - Country:US
Practice Address - Phone:252-312-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist