Provider Demographics
NPI:1962784447
Name:KENNY, JULIE D (AUD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:KENNY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-326-8630
Mailing Address - Fax:309-268-3213
Practice Address - Street 1:2502 E EMPIRE ST STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3739
Practice Address - Country:US
Practice Address - Phone:217-383-3130
Practice Address - Fax:217-383-4451
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001405231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist