Clifford McKennon, SLPA

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

33902 Issued in TX

Practice address

1052 E Washington St
Stephenville, TX 76401-4558

Phone

(254) 965-3611

Fax

(254) 965-3618

NPI assigned

Jan 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Countryside Therapy Group, Inc

  • Rehabilitation Clinic/Center
  • Stephenville, TX
  • NPI 1710999289
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285787432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 N HIGHWAY 281",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760672509",
            "telephone_number": "940-325-1072",
            "fax_number": "254-965-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 E WASHINGTON ST",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764014558",
            "telephone_number": "254-965-3611",
            "fax_number": "254-965-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNON",
        "first_name": "CLIFFORD",
        "name_prefix": "Mr.",
        "credential": "SLPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "TX",
            "license": "33902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison McBride
• Ashton McCall-Ezell
• Charity McCright, ATC
• Breynia N McGee
• Laura Leigh McGuyer, R.D.
• Tina Beth McLean, RN,BSN,CNOR,RNFA
• Janie McMillion, M.D.
• Michael Scott McNeal, OD
• Hayden Brock McPherson
• Andrea Michelle McPhillips, DDS; MD

• Speech-Language Assistant in Stephenville, TX
• Providers in Stephenville, TX by specialty
• Speech-Language Assistant in Texas

• 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.

Verify at the official NPI Registry.