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General NPI Number Information
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NPI Number | 1336684034
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Entity Type | Organization
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Legal Business Name | KENNAMAR-LINN LLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 3350 BURBERRY PL
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8754
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Country | US
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Telephone | 407-622-9603
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Fax | 321-805-4915
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Provider Business Mailing Address
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Address Line | 3350 BURBERRY PL
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8754
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Country | US
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Telephone | 407-622-9603
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Fax | 321-805-4915
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PEGGY KENNAMER-LINN
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Credential | LMHC
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Telephone | 407-622-9603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MH13013
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License Number State | FL
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