Provider Demographics
NPI:1487929113
Name:KANE, JEANETTE NADINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:NADINE
Last Name:KANE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:NADINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1071 CALLAWAY CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-5209
Mailing Address - Country:US
Mailing Address - Phone:734-678-6028
Mailing Address - Fax:
Practice Address - Street 1:1071 CALLAWAY CT
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-5209
Practice Address - Country:US
Practice Address - Phone:734-678-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12139166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist