NPIMap

Organization Active NPI

Kennelly Speech Language Pathology LTD

  • Speech-Language Pathologist
  • Fargo, ND
National Provider Identifier
1154370187
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
664 Issued in ND
Legal business name
KENNELLY SPEECH LANGUAGE PATHOLOGY LTD
Practice address
4450 31St Ave S
Suite 103
Fargo, ND 58104
Phone
(701) 364-5433
Fax
(701) 364-5431
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nanette S KennellyNPI 1316160914
Title
Owner
Phone
(701) 364-5433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 664 ND Primary
Hearing and Speech Clinic/Center 261QH0700X

Addresses

Primary practice location

4450 31St Ave S
Suite 103
Fargo, ND 58104

Mailing address

4450 31St Ave S
Suite 103
Fargo, ND 58104
Phone (701) 364-5433

Other identifiers 1

IdentifierTypeStateIssuer
1457254MedicaidND

Other names 1

  • Onword therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101118001445 ND Part B Supplier - Clinic/Group Practice 8921292707 Receives reassigned benefits from 8 practitioners
Practice locations: Fargo, ND

National Provider Directory

National Provider Directory

Locations

1220 Main Ave
Ste 120
Fargo, ND 58103
Phone (701) 364-5433

4450 31st Ave S
Ste 103
Fargo, ND 58104
Phone (701) 364-5433

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1154370187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 31ST AVE S",
            "address_2": "SUITE 103",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58104",
            "telephone_number": "701-364-5433",
            "fax_number": "701-364-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 31ST AVE S",
            "address_2": "SUITE 103",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58104",
            "telephone_number": "701-364-5433",
            "fax_number": "701-364-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNELLY SPEECH LANGUAGE PATHOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "KENNELLY",
        "authorized_official_first_name": "NANETTE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-364-5433"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "664",
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457254",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Onword therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.