Healthcare Provider Details

I. General information

NPI: 1407753536
Provider Name (Legal Business Name): KENNEDY CREEK BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2026
Last Update Date: 10/22/2026
Certification Date: 10/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E MAIN ST
ADRIAN MO
64720-8201
US

IV. Provider business mailing address

PO BOX 67
ADRIAN MO
64720-0067
US

V. Phone/Fax

Practice location:
  • Phone: 816-805-2503
  • Fax: 816-280-4874
Mailing address:
  • Phone: 816-805-2503
  • Fax: 816-280-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VANESSA M KENNEDY
Title or Position: CEO
Credential: INSTRUCTOR, PEER
Phone: 816-805-2503