Healthcare Provider Details

I. General information

NPI: 1063329001
Provider Name (Legal Business Name): CODI KENNEY MS CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21799 KINGS WAY
PROCTOR MT
59929-9612
US

IV. Provider business mailing address

21799 KINGS WAY
PROCTOR MT
59929-9612
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-3554
  • Fax:
Mailing address:
  • Phone: 406-407-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPRD-LTD-LIC-331
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: