Healthcare Provider Details

I. General information

NPI: 1548184930
Provider Name (Legal Business Name): KENNEDY M ODULIO-PAPA LP, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 MADISON AVE
INDIANAPOLIS IN
46227-6066
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-5122
  • Fax: 317-888-8642
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20044075A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20044075B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: