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NPI Code Detail

MEDICARE: MRS. MICHELLE M. KENNEY LSW

MEDICARE: MRS. MICHELLE M. KENNEY LSW
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
1104100000XSocial Worker0900505OH

General Provider Information

NPI Number : 1588918213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE M. KENNEY LSW
Provider Business Mailing Address
First Line : 141 PARK DR
Second Line :
City : XENIA
State : OH
Zip : 45385-2246
Country : US
Telephone Number : 937-252-0100
Fax Number : 937-258-4261
Provider Business Practice Location Address
First Line : 2745 S SMITHVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45420-2668
Country : US
Telephone Number : 937-252-0100
Fax Number : 937-258-4261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2012
Last Update Date : 11/02/2012

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