Provider Demographics
NPI:1841328804
Name:KESSENICH, JAMES MICHAEL (MS CCC SLP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:KESSENICH
Suffix:
Gender:M
Credentials:MS CCC SLP
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Mailing Address - Street 1:733 E CHOCTAW
Mailing Address - Street 2:COMMUNICATION ENRICHMENT SERVICES LLC
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-600-4191
Mailing Address - Fax:
Practice Address - Street 1:733 E CHOCTAW
Practice Address - Street 2:COMMUNICATION ENRICHMENT SERVICES LLC
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-600-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist