Provider Demographics
NPI:1285854422
Name:KENNER, SARAH V (SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:V
Last Name:KENNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:PAYTON-HARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 COLLUM LN W
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-5003
Mailing Address - Country:US
Mailing Address - Phone:479-632-4717
Mailing Address - Fax:
Practice Address - Street 1:1220 COLLUM LN W
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-5003
Practice Address - Country:US
Practice Address - Phone:479-632-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150668721Medicaid