Healthcare Provider Details

I. General information

NPI: 1770755878
Provider Name (Legal Business Name): KENNEDY KRIEGER EDUCATION AND COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 GREENSPRING AVE. KENNEDY KRIEGER SCHOOL - HIGH SCHOOL
BALTIMORE MD
21211
US

IV. Provider business mailing address

P.O. BOX 744865
ATLANTA GA
30374
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • 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 NEUMAN
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 443-923-1810