=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407753536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNEDY CREEK BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2026
-----------------------------------------------------
Last Update Date | 10/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 E MAIN ST
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64720-8201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-805-2503
-----------------------------------------------------
Fax | 816-280-4874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 67
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64720-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-805-2503
-----------------------------------------------------
Fax | 816-280-4874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VANESSA M KENNEDY
-----------------------------------------------------
Credential | INSTRUCTOR, PEER
-----------------------------------------------------
Telephone | 816-805-2503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------