| Doctor Name: | MR. KEN WESLEY ANDERSON |
| NPI Number: | 1568883114 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CCC-SLP |
| License Number: | 024753 |
| Business Practice Address: | 5 Kent St Farmingdale, NY - 117354001 |
| Business Phone Number: | 9097678962 |
| Business Fax Number: | |
| Mailing Address: | 5 Kent St, FARMINGDALE |
| State: | NY |
| Postal Code: | 117354001 |
| Phone Number: | 9097678962 |
| Fax Number: | |
| NPI Enumeration Date: | 12/30/2013 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 024753 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |