Healthcare Provider Details

I. General information

NPI: 1720901770
Provider Name (Legal Business Name): KENNEDY ABA AK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 OLD DAIRY RD
JUNEAU AK
99801-8094
US

IV. Provider business mailing address

8585 OLD DAIRY RD STE 208
JUNEAU AK
99801-8094
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-6664
  • Fax: 984-266-6765
Mailing address:
  • Phone: 888-360-6664
  • Fax: 984-266-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YITZCHOK ISSAC CZIMENT
Title or Position: OWNER
Credential: CZIMENT
Phone: 888-360-6664