Provider Demographics
NPI:1285981282
Name:KENNEY, LOUISE ANNE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:ANNE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COUNTRYSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-558-2105
Mailing Address - Fax:
Practice Address - Street 1:20 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-9678
Practice Address - Country:US
Practice Address - Phone:802-558-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01077126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT01077126OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION