Individual provider Active NPI

Beth A Kennedy, MS, CCC-SLP

  • Speech-Language Pathologist
  • Victor, NY
National Provider Identifier
1366712697
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
011879-01 Issued in NY
Practice address
590 Fishers Station Dr Ste 130
Victor, NY 14564-9744
Phone
(585) 924-7207
NPI assigned
Jan 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP-10247 OH
Speech-Language Pathologist 235Z00000X 011879-01 NY Primary

Addresses

Primary practice location

590 Fishers Station Dr Ste 130
Victor, NY 14564-9744

Mailing address

590 Fishers Station Dr Ste 130
Victor, NY 14564-9744
Phone (585) 924-7207

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

LicenseStateTypeSpecialty
011879-01NYMDSpeech-Language Pathologist
SP-10247OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Speech Therapy LLC Speech-Language Pathologist Past Accepting new patients
Western New York Speech-Language Pathology, OT, and PT Consultants Speech-Language Pathologist PastSince Jul 17, 2022 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1366712697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FISHERS STATION DR STE 130",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649744",
            "telephone_number": "585-924-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FISHERS STATION DR STE 130",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649744",
            "telephone_number": "585-924-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "BETH",
        "middle_name": "A",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-03",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP-10247",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "011879-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.