MEDICARE: ALLYSON MARIE KENNEDY M.S., CF-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

General Provider Information

NPI Number	:	1902522022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON MARIE KENNEDY M.S., CF-SLP

Provider Business Mailing Address
First Line	:	91 REID AVE
Second Line	:
City	:	ROCKAWAY POINT
State	:	NY
Zip	:	11697-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4526
Country	:	US
Telephone Number	:	718-444-4316
Fax Number	:

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

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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