MEDICARE: BERNADETTE MARLENE KENNARD

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	9152	CA

General Provider Information

NPI Number	:	1699364406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE MARLENE KENNARD

Provider Business Mailing Address
First Line	:	PO BOX 17988
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-7988
Country	:	US
Telephone Number	:	562-999-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 E JACKSON ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6129
Country	:	US
Telephone Number	:	562-999-1292
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “ BERNADETTE MARLENE KENNARD ” Practice Location

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