Jacqueline Kay Kenyon, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6951 Issued in AZ

Practice address

3555 E Fry Blvd
Sierra Vista, AZ 85635-2972

Phone

(520) 515-2790

NPI assigned

Dec 21, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Jacqueline Kay Burds Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Dynamite Therapy, LLC

  • Home Health Agency
  • Scottsdale, AZ
  • NPI 1730388828
  NPD (past)

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292889600000",
    "number": "1437452000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 EAST FRY BOULEVARD",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "85635",
            "telephone_number": "520-515-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 E FRY BLVD",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352972",
            "telephone_number": "520-515-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENYON",
        "first_name": "JACQUELINE",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-21",
        "last_updated": "2010-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "6951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "#SLP6951",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "BURDS",
            "middle_name": "KAY",
            "prefix": "MISS",
            "credential": "M.S. CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erika K Keller
• Corneta E. Kelley, M.A.,CCC-SLP
• Kelly Brett Smith Chiropractic PLLC
• Robert Victor Kelly III, PT, DPT
• Derek Jerred Kent, COTA/L
• Katherine M Kerley, MC, LPC
• Kerstin P. Hurley, PHD
• Keyamed, Inc a P C
• Abdul Rahman Rizwan Ahmed Khan, MD
• Habiba Yaqub Khan, MD

• Speech-Language Pathologist in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.