Healthcare Provider Details

I. General information

NPI: 1104029214
Provider Name (Legal Business Name): ANNA C KENNERKNECHT AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 CROCKER RD STE 8
WESTLAKE OH
44145-1072
US

IV. Provider business mailing address

815 CROCKER RD STE 8
WESTLAKE OH
44145-1072
US

V. Phone/Fax

Practice location:
  • Phone: 440-438-3401
  • Fax: 440-999-8924
Mailing address:
  • Phone: 440-438-3401
  • Fax: 440-999-8924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number6606
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number310
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA.02285
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number310
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6606
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: