Healthcare Provider Details

I. General information

NPI: 1619697695
Provider Name (Legal Business Name): ROBERT ADAM KENNARD BA, CDCA, CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 GLENCROSSING WAY
CINCINNATI OH
45238-3361
US

IV. Provider business mailing address

2909 CARR ST
ASHLAND KY
41102-5504
US

V. Phone/Fax

Practice location:
  • Phone: 513-827-9044
  • Fax:
Mailing address:
  • Phone: 606-471-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.185458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: