Active NPI
Marcilyn Renee Kennedy, M.S., CCC-SLP
- Speech-Language Pathologist
- Sherwood, AR
National Provider Identifier
1417025263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2237
- Practice address
- 9210 Trail Run Rd
Sherwood, AR 72120-9422 - Phone
- (501) 834-4100
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 2237 | AR | Primary |
Addresses
Primary practice location
9210 Trail Run Rd
Sherwood, AR 72120-9422
Mailing address
9210 Trail Run Rd
Sherwood, AR 72120-9422
Phone (501) 834-4100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y158 | Other | AR | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 2237 | AR | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Just for Kids Therapy Services | Speech-Language Pathologist | Past | Accepting new patients |
| Just for Kids Therapy Services | Speech-Language Pathologist | Past | 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.
-
- Speech-Language Pathologist
- Sherwood, AR
- NPI 1265404917
-
- Speech-Language Pathologist
- Sherwood, AR
- NPI 1457421042
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417025263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9210 TRAIL RUN RD",
"city": "SHERWOOD",
"state": "AR",
"postal_code": "721209422",
"telephone_number": "501-834-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9210 TRAIL RUN RD",
"city": "SHERWOOD",
"state": "AR",
"postal_code": "721209422",
"telephone_number": "501-834-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MARCILYN",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "2237",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5Y158",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sherwood, AR
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.