Individual
TARA KENYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
5700 W LAYTON AVE, GREENFIELD, WI 53220-4016
(414) 325-4069
Mailing address
5700 W LAYTON AVE, GREENFIELD, WI 53220-4016
(414) 325-4069
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3398-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3398-154
—
WI
Enumeration date
11/03/2010
Last updated
11/03/2010
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