Provider Demographics
NPI:1821408469
Name:KENNEDY, DEBORAH (MS)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:182 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3226
Mailing Address - Country:US
Mailing Address - Phone:440-428-8655
Mailing Address - Fax:
Practice Address - Street 1:341 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-2785
Practice Address - Country:US
Practice Address - Phone:440-392-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist