MEDICARE: MRS. DANIELLE YVONNE KENNEDY M.S., CCC-A

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	AUD190	CO

General Provider Information

NPI Number	:	1346411436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE YVONNE KENNEDY M.S., CCC-A

Provider Business Mailing Address
First Line	:	511 S SIMMS ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2909
Country	:	US
Telephone Number	:	303-200-0197
Fax Number	:

Provider Business Practice Location Address
First Line	:	13952 DENVER WEST PKWY STE 325
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3143
Country	:	US
Telephone Number	:	720-974-9757
Fax Number	:	720-974-0248

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/20/2013

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