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General NPI Number Information
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NPI Number | 1255143129
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Entity Type | Individual
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Provider Name | CASSANDRA MAE KENNISON AAP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 656 BEANVILLE RD
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City | VERSHIRE
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State | VT
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Zip | 05079-4424
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Country | US
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Telephone | 802-498-5816
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Fax |
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Provider Business Mailing Address
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Address Line | 254 PLAINFIELD RD
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City | WEST LEBANON
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State | NH
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Zip | 03784-2001
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Country | US
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Telephone | 603-298-2146
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Fax | 603-298-2149
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 149.0134026
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License Number State | VT
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