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General NPI Number Information
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NPI Number | 1528456985
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Entity Type | Individual
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Provider Name | MEGAN KENNEDY- KOTALIK LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 509 N WINNETKA AVE
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City | DALLAS
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State | TX
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Zip | 75208-5141
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Country | US
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Telephone | 972-755-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 816 EDGEFIELD DR
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City | RICHARDSON
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State | TX
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Zip | 75080-4032
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Country | US
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Telephone | 214-729-9194
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 60759
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License Number State | TX
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