Basic Information
| Provider Information | |||||||||
| NPI: | 1508877721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EARWOOD | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 POWDER MILL ROAD | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038334318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106904033 | ||||||||
| FaxNumber: | 8662105259 | ||||||||
| Practice Location | |||||||||
| Address1: | 989 OCEAN BLVD | ||||||||
| Address2: | UNIT 10 | ||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038421453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036012752 | ||||||||
| FaxNumber: | 8662105259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5298 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7411680 | 05 | NC | MEDICAID | 1317K | 01 | NC | BCBS | OTHER | 30407908 | 05 | NH | MEDICAID |