NPI | 1780311316 |
---|---|
Former Name | KENNEDY BREA BLUE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: AR 201971) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
Enumeration Date | 2022-08-03 |
Last Update Date | 2023-09-27 |