MEDICARE: MS. ERIN S KENNEDY M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1194700930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN S KENNEDY M.S.

Provider Business Mailing Address
First Line	:	5755 COTTLE RD # 1
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 COTTLE RD
Second Line	:	BLDG 1
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3640
Country	:	US
Telephone Number	:	408-972-3331
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/12/2007

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