Healthcare Provider Details

I. General information

NPI: 1376715383
Provider Name (Legal Business Name): KENNEDY KRIEGER EDUCATION AND COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E. 32ND ST. MONTEBELLO SCHOOL
BALTIMORE MD
21218
US

IV. Provider business mailing address

PO BOX 744865 PATIENT ACCOUNTING HELENA PORTER
ATLANTA GA
30374
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-4801
  • Fax: 443-923-9405
Mailing address:
  • Phone: 443-923-1886
  • Fax: 443-923-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number30-036
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. MIKE J NEUMAN
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 443-923-1810