MEDICARE: KENALYN M. CROMWELL M.S., CCC-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	SA3082	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790917599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENALYN M. CROMWELL M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	912 KRISTANNA DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3278
Country	:	US
Telephone Number	:	850-252-2628
Fax Number	:	850-215-7809

Provider Business Practice Location Address
First Line	:	230 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4919
Country	:	US
Telephone Number	:	850-481-0419
Fax Number	:	850-215-7809

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

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	05/25/2015

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Directions to “ KENALYN M. CROMWELL M.S., CCC-SLP” Practice Location

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