Healthcare Provider Details

I. General information

NPI: 1285026534
Provider Name (Legal Business Name): KATHERYN M KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERYN M SMITH

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 ARLINGTON BLVD
SPANISH FORT AL
36527-5832
US

IV. Provider business mailing address

11510 ARLINGTON BLVD
SPANISH FORT AL
36527-5832
US

V. Phone/Fax

Practice location:
  • Phone: 251-209-1802
  • Fax: 251-217-9101
Mailing address:
  • Phone: 251-209-1802
  • Fax: 251-217-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3719
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: