Doctor Name: | MARY JEANETTE MCKENNON |
NPI Number: | 1841375839 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 10142 |
Business Practice Address: | 515 W Lingleville Rd Stephenville, TX - 764012211 |
Business Phone Number: | 2549653611 |
Business Fax Number: | 2549653618 |
Mailing Address: | 5909 N Highway 281, MINERAL WELLS |
State: | TX |
Postal Code: | 760672509 |
Phone Number: | 9403251072 |
Fax Number: | 9403270904 |
NPI Enumeration Date: | 10/26/2006 |
NPI Last Update Date: | 05/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 10142 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |