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General NPI Number Information
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NPI Number | 1174922322
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Entity Type | Organization
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Legal Business Name | KENNEDY PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 155 NE 100TH ST
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City | SEATTLE
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State | WA
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Zip | 98125-8012
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Country | US
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Telephone | 206-619-9833
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Fax |
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Provider Business Mailing Address
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Address Line | 3432 E FLORENCE CT
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City | SEATTLE
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State | WA
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Zip | 98112-4936
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Country | US
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Telephone | 206-619-9833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL PSYCHOLOGIST
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Name | DR. MELISSA JANE KENNEDY
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Credential | PHD
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Telephone | 206-619-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 000003822
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License Number State | WA
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