Provider Demographics
NPI:1871774463
Name:KENNEY-MICHAUD, KRISTINE L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:KENNEY-MICHAUD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:L
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:87 BAYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-1819
Mailing Address - Country:US
Mailing Address - Phone:508-264-3051
Mailing Address - Fax:
Practice Address - Street 1:1610 G A R HWY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1210
Practice Address - Country:US
Practice Address - Phone:508-677-9797
Practice Address - Fax:508-677-9922
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-24
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5036235Z00000X
RISP00864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist