MEDICARE: KENNEDY COWART CF-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	PCET003056	GA

General Provider Information

NPI Number	:	1649891227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY COWART CF-SLP

Provider Business Mailing Address
First Line	:	1107 GREER ST
Second Line	:	STE A-B
City	:	CORDELE
State	:	GA
Zip	:	31015-1920
Country	:	US
Telephone Number	:	229-273-9445
Fax Number	:	229-273-9447

Provider Business Practice Location Address
First Line	:	414 N WESTOVER BLVD STE B
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2102
Country	:	US
Telephone Number	:	229-292-3704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	05/27/2020

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Directions to “ KENNEDY COWART CF-SLP” Practice Location

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