Healthcare Provider Details

I. General information

NPI: 1760087704
Provider Name (Legal Business Name): NORAH CELESTE HASS KENNEDY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

IV. Provider business mailing address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-8332
  • Fax:
Mailing address:
  • Phone: 612-208-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3890-57
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7327
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: