Provider Demographics
NPI:1699168021
Name:BETZ, KENDRAH T (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRAH
Middle Name:T
Last Name:BETZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 POLARIS PKWY STE 86
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2041
Mailing Address - Country:US
Mailing Address - Phone:614-547-2511
Mailing Address - Fax:
Practice Address - Street 1:214 BLUEGLADE DR
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-7618
Practice Address - Country:US
Practice Address - Phone:614-547-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10726235Z00000X
OHSP10726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist