Healthcare Provider Details

I. General information

NPI: 1861773822
Provider Name (Legal Business Name): K&C EDUCATIONAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 HOPETOWN RD
CHILLICOTHEE OH
45601-8863
US

IV. Provider business mailing address

205 N HIGH ST
CHILLICOTHEE OH
45601-2408
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-2343
  • Fax: 740-774-4757
Mailing address:
  • Phone: 740-773-2343
  • Fax: 740-775-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCERTIFIED
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.7198
License Number StateOH

VIII. Authorized Official

Name: DR. EDDIE JEAN KERNEY III
Title or Position: DYSLEXIA AND ADHD SPECIALIST
Credential: PH.D.
Phone: 740-773-2343