Provider Demographics
NPI:1063877918
Name:HENNESSEY, KELLIE MICHELLE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:MICHELLE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 BELLECREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1711
Mailing Address - Country:US
Mailing Address - Phone:937-671-3934
Mailing Address - Fax:
Practice Address - Street 1:7265 KENWOOD RD STE 363
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4411
Practice Address - Country:US
Practice Address - Phone:513-635-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist