MEDICARE: HEIDI KENNEDY SLP

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	235Z00000X	Speech-Language Pathologist	5571	CA

General Provider Information

NPI Number	:	1194015180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI KENNEDY SLP

Provider Business Mailing Address
First Line	:	9 LACRUE AVE
Second Line	:	SUITE 210
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1062
Country	:	US
Telephone Number	:	800-578-7906
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 E MOUNTAIN VIEW DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1944
Country	:	US
Telephone Number	:	619-922-9903
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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Directions to “ HEIDI KENNEDY SLP” Practice Location

Language	Start Address	Practice Location

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