Provider Demographics
NPI:1972381424
Name:FANNING, KENDRA L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:FANNING
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 1:720 RENA RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6403
Mailing Address - Country:US
Mailing Address - Phone:479-471-3190
Mailing Address - Fax:479-471-3190
Practice Address - Street 1:720 RENA RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6403
Practice Address - Country:US
Practice Address - Phone:479-471-3190
Practice Address - Fax:479-471-3193
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist