Active NPI
Regina Marie Kennedy, MED CCC SLP LICENSE
- Speech-Language Pathologist
- Bradford, PA
National Provider Identifier
1114142189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL001518L
- Practice address
- 110 Campus Drive
Bradford, PA 16701 - Phone
- (814) 887-5591
- Fax
- (814) 887-5666
- NPI assigned
- Apr 16, 2007
- 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 | SL001518L | PA | Primary |
Addresses
Primary practice location
110 Campus Drive
Bradford, PA 16701
Mailing address
190 Old Mill Rd
Kane, PA 16735
Phone (814) 837-6735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018796900002 | Medicaid | PA |
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 Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL001518L | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114142189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 OLD MILL RD",
"city": "KANE",
"state": "PA",
"postal_code": "16735",
"telephone_number": "814-837-6735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CAMPUS DRIVE",
"city": "BRADFORD",
"state": "PA",
"postal_code": "16701",
"telephone_number": "814-887-5591",
"fax_number": "814-887-5666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "REGINA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MED CCC SLP LICENSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL001518L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018796900002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.