Individual
NANETTE S KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
1220 MAIN AVE, SUITE 100, FARGO, ND 58103-8201
(701) 364-5433
(701) 364-2256
Mailing address
PO BOX 746, FARGO, ND 58107-0746
(701) 364-5433
(701) 364-2256
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
664
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26042
ND BCBS
ND
05
—
50906
—
ND
Enumeration date
04/11/2007
Last updated
07/09/2007
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