Phyllis Antoinette Kenworthy, M.A.CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12201 Issued in CA

Practice address

3700 South St
Lakewood, CA 90712-1419

Phone

(562) 272-6497

NPI assigned

Mar 3, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236211200000",
    "number": "1992945919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18627 BROOKHURST ST",
            "address_2": "#104",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086748",
            "telephone_number": "714-312-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTH ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121419",
            "telephone_number": "562-272-6497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENWORTHY",
        "first_name": "PHYLLIS",
        "middle_name": "ANTOINETTE",
        "credential": "M.A.CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-03",
        "last_updated": "2009-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "12201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Lee Keller
• Breonna Kelley
• Gail Duane Kelley, D.C.
• Wanda Kenlow, IBCLC
• Kenny Young Kim DDS Inc
• Aaron R Kern, MD
• Sarah Kessler, CD(DONA)
• Joseph Kestenbaum, PH.D.
• Cleveland Key
• Khai H. Tran, D.D.S., Inc.

• Speech-Language Pathologist in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.