Healthcare Provider Details

I. General information

NPI: 1780521526
Provider Name (Legal Business Name): KISMIT JANEL KENNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KISMIT JOHNSON

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CARING ST
HILLMAN MI
49746-8818
US

IV. Provider business mailing address

631 CARING ST
HILLMAN MI
49746-8818
US

V. Phone/Fax

Practice location:
  • Phone: 231-492-4960
  • Fax:
Mailing address:
  • Phone: 231-492-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004489
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: