Provider Demographics
NPI:1134426935
Name:KENNEDY, MAUREEN A (SLP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CHALFONT PL
Mailing Address - Street 2:APT G421
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9159
Mailing Address - Country:US
Mailing Address - Phone:412-853-9968
Mailing Address - Fax:
Practice Address - Street 1:421 CHALFONT PL
Practice Address - Street 2:APT G421
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9159
Practice Address - Country:US
Practice Address - Phone:412-853-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004790L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist