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General NPI Number Information
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NPI Number | 1346657426
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Entity Type | Organization
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Legal Business Name | JOSEPH KENNELL PHD
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 3705 EMERSON AVE
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City | PARKERSBURG
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State | WV
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Zip | 26104-1118
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Country | US
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Telephone | 304-865-0272
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Fax | 304-865-0265
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Provider Business Mailing Address
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Address Line | 3705 EMERSON AVEUNE
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City | PARKERSBURG
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State | WV
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Zip | 26104-1118
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Country | US
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Telephone | 304-865-0272
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Fax | 304-865-0265
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBIE M TIPPENS
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Credential |
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Telephone | 304-865-0274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 557
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License Number State | WV
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