Basic Information
| Provider Information | |||||||||
| NPI: | 1174179105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENAWELL | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148894463 | ||||||||
| FaxNumber: | 8148894902 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148894463 | ||||||||
| FaxNumber: | 8148894902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2019 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PSL000974 | PA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SL015080 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.