Healthcare Provider Details

I. General information

NPI: 1497532543
Provider Name (Legal Business Name): MARISSA KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA KUHN

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E MARYDALE AVE
SOLDOTNA AK
99669-7648
US

IV. Provider business mailing address

PO BOX 2949
SOLDOTNA AK
99669-2949
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-3119
  • Fax: 907-262-9290
Mailing address:
  • Phone: 907-395-4399
  • Fax: 907-262-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number250943
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: