Provider Demographics
NPI:1124298658
Name:KANKEY, BRENDA ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:KANKEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:CAMPBELL
Other - Last Name:KANKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:109 IVY LN
Mailing Address - Street 2:
Mailing Address - City:BULL SHOALS
Mailing Address - State:AR
Mailing Address - Zip Code:72619-2814
Mailing Address - Country:US
Mailing Address - Phone:870-445-2985
Mailing Address - Fax:
Practice Address - Street 1:109 IVY LN
Practice Address - Street 2:
Practice Address - City:BULL SHOALS
Practice Address - State:AR
Practice Address - Zip Code:72619-2814
Practice Address - Country:US
Practice Address - Phone:870-445-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist