Healthcare Provider Details

I. General information

NPI: 1164220042
Provider Name (Legal Business Name): KENNEDY KRIEGER ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 N BROADWAY
BALTIMORE MD
21205-1806
US

IV. Provider business mailing address

PO BOX 45944
BALTIMORE MD
21297-5944
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-3260
  • Fax: 443-923-9575
Mailing address:
  • Phone: 443-923-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA BADIE
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 443-923-1812