Active NPI
Kennedi Barham, M.S. CCC-SLP
- Speech-Language Pathologist
- Fairfield, TX
National Provider Identifier
1063140671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 120000
- Practice address
- 225 W Reunion St
Fairfield, TX 75840-1836 - Phone
- (903) 389-3372
- NPI assigned
- Aug 11, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 120000 | TX | Primary |
Addresses
Primary practice location
225 W Reunion St
Fairfield, TX 75840-1836
Mailing address
9846 Hwy 31 E
Tyler, TX 75705-2329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120000 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722384000000",
"number": "1063140671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9846 HWY 31 E",
"city": "TYLER",
"state": "TX",
"postal_code": "757052329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 W REUNION ST",
"city": "FAIRFIELD",
"state": "TX",
"postal_code": "758401836",
"telephone_number": "903-389-3372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARHAM",
"first_name": "KENNEDI",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-11",
"last_updated": "2024-07-31",
"certification_date": "2024-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "120000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.