Healthcare Provider Details

I. General information

NPI: 1366105256
Provider Name (Legal Business Name): KENISHA MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W JEFFERSON AVE STE 202
LAKEWOOD CO
80235-2023
US

IV. Provider business mailing address

713 VILLAGE SQAURE CIR APT 614
DELRAY BEACH FL
33444
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-7673
  • Fax: 866-283-0595
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: