Provider Demographics
NPI:1649444639
Name:HENNESSY, IRENE MAY (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MAY
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18725 STRATTON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-7008
Mailing Address - Country:US
Mailing Address - Phone:714-375-0525
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 179
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3822
Practice Address - Country:US
Practice Address - Phone:714-596-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist