MEDICARE: DR. KAREN ANN KENNEDY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A00512	OH
2	235Z00000X	Speech-Language Pathologist	SP6830	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010795	OTHER	OH	BCMH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154328383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN ANN KENNEDY PH.D.

Provider Business Mailing Address
First Line	:	10305 HUNTING HILLS AVE NE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9788
Country	:	US
Telephone Number	:	330-877-4262
Fax Number	:	330-877-4262

Provider Business Practice Location Address
First Line	:	10305 HUNTING HILLS AVE NE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9788
Country	:	US
Telephone Number	:	330-877-4262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	09/11/2025

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