Healthcare Provider Details

I. General information

NPI: 1952151763
Provider Name (Legal Business Name): KENNEDY RYANN WALL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD STE 101
ANKENY IA
50023-9417
US

IV. Provider business mailing address

2920 NW 20TH LN UNIT 204
ANKENY IA
50023-9387
US

V. Phone/Fax

Practice location:
  • Phone: 515-989-8266
  • Fax:
Mailing address:
  • Phone: 402-214-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number124165
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: