Individual
JESSICA BROOKE KENWORTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CF-SLP
Contact information
Practice address
125 PRESUMPSCOT ST UNIT 10, PORTLAND, ME 04103-5225
(207) 747-5394
Mailing address
65 SPRUCE ST APT 2, PORTLAND, ME 04102-4068
(617) 710-7108
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
ST2905
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ST2905
STATE OF MAINE- TEMPORARY SPEECH LANGUAGE PATHOLOGIST
ME
Enumeration date
04/07/2019
Last updated
06/11/2019
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