Provider Demographics
NPI:1306483227
Name:KENNY, HALEY-JO (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:HALEY-JO
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5404
Mailing Address - Country:US
Mailing Address - Phone:718-621-0569
Mailing Address - Fax:
Practice Address - Street 1:7000 21ST AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5404
Practice Address - Country:US
Practice Address - Phone:718-236-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029381-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist