MEDICARE: DR. KERRY KENNEDY-PRESSEY PHD, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	5998213-3501	UT

General Provider Information

NPI Number	:	1134393341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY KENNEDY-PRESSEY PHD, LCSW

Provider Business Mailing Address
First Line	:	880 HERITAGE PARK BLVD STE 130
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5674
Country	:	US
Telephone Number	:	801-917-5564
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 HERITAGE PARK BLVD
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5676
Country	:	US
Telephone Number	:	801-917-5564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	02/20/2024

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