Healthcare Provider Details

I. General information

NPI: 1639421944
Provider Name (Legal Business Name): MEGAN MARIE KENNY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W DAYTON ST
MADISON WI
53703-1995
US

IV. Provider business mailing address

5927 WOODLAND DR
WAUNAKEE WI
53597-9104
US

V. Phone/Fax

Practice location:
  • Phone: 608-663-1879
  • Fax:
Mailing address:
  • Phone: 414-687-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number817107
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: