Healthcare Provider Details

I. General information

NPI: 1922697069
Provider Name (Legal Business Name): DR. JOELLEN KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13208 TURQUOISE CIR
CARMEL IN
46033-2369
US

IV. Provider business mailing address

13208 TURQUOISE CIR
CARMEL IN
46033-2369
US

V. Phone/Fax

Practice location:
  • Phone: 317-946-3708
  • Fax:
Mailing address:
  • Phone: 317-946-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34003257A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: