Provider Demographics
NPI:1811348246
Name:KENNON, SAUNDRA (SLPA)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:KENNON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17737 W STELLA LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9641
Mailing Address - Country:US
Mailing Address - Phone:602-206-0806
Mailing Address - Fax:
Practice Address - Street 1:19670 E REINS RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8681
Practice Address - Country:US
Practice Address - Phone:480-528-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA99352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant