=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407658008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH KENNARD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 MCDONALD AVE STE 101
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-7343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-290-9788
-----------------------------------------------------
Fax | 866-337-1003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 288 CAPDEVILLA
-----------------------------------------------------
City | LOLO
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59847-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-290-9788
-----------------------------------------------------
Fax | 866-337-1003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH KENNARD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 406-290-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------