Provider Demographics
NPI:1295499150
Name:KENESSON, ELIZABETH ALLISON
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALLISON
Last Name:KENESSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N CHARLTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4535
Mailing Address - Country:US
Mailing Address - Phone:409-283-7152
Mailing Address - Fax:
Practice Address - Street 1:505 N CHARLTON ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4535
Practice Address - Country:US
Practice Address - Phone:409-283-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist