Basic Information
Provider Information
NPI: 1003003112
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KENNEDY
FirstName: ALLISON
MiddleName: P.
NamePrefix: MRS.
NameSuffix:  
Credential: M.A., CCC/A
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5575 WARREN PKWY
Address2: #104
City: FRISCO
State: TX
PostalCode: 750344062
CountryCode: US
TelephoneNumber: 4696339595
FaxNumber: 4696339460
Practice Location
Address1: 5575 WARREN PKWY
Address2: #104
City: FRISCO
State: TX
PostalCode: 750344062
CountryCode: US
TelephoneNumber: 4696339595
FaxNumber: 4696339460
Other Information
ProviderEnumerationDate: 10/02/2007
LastUpdateDate: 10/02/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X51608TXY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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