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General NPI Number Information
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NPI Number | 1790917599
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Entity Type | Individual
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Provider Name | KENALYN M. CROMWELL M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 05/25/2015
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Provider Practice Location Address
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Address Line | 230 FOREST PARK CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4919
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Country | US
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Telephone | 850-481-0419
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Fax | 850-215-7809
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Provider Business Mailing Address
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Address Line | 912 KRISTANNA DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-3278
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Country | US
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Telephone | 850-252-2628
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Fax | 850-215-7809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA3082
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License Number State | FL
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