Provider Demographics
NPI:1306093638
Name:KENNEDY, LEISA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-3071
Mailing Address - Country:US
Mailing Address - Phone:501-425-6834
Mailing Address - Fax:
Practice Address - Street 1:708 E DIXON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-4114
Practice Address - Country:US
Practice Address - Phone:501-490-5837
Practice Address - Fax:501-490-5846
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist