Healthcare Provider Details

I. General information

NPI: 1609796424
Provider Name (Legal Business Name): KENNEDY PENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NORTH ST
HILLSDALE MI
49242-1628
US

IV. Provider business mailing address

204 S UNION ST
READING MI
49274-9577
US

V. Phone/Fax

Practice location:
  • Phone: 517-607-9747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: