Healthcare Provider Details

I. General information

NPI: 1376999409
Provider Name (Legal Business Name): MARCIA KENNEDY LCP, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA KENNEDY LCP, LSCSW

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 N WOODCHUCK ST STE F
WICHITA KS
67212-3571
US

IV. Provider business mailing address

1113 N VALLEYVIEW ST
WICHITA KS
67212-4367
US

V. Phone/Fax

Practice location:
  • Phone: 316-371-7226
  • Fax: 888-527-4437
Mailing address:
  • Phone: 316-371-7226
  • Fax: 888-527-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1498
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4695
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: