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General NPI Number Information
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NPI Number | 1649094715
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Entity Type | Organization
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Legal Business Name | KENNEDY ADMINISTRATION
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3612 WEST NORTH AVENUE
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City | MILWAUKEE
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State | WI
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Zip | 53208
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Country | US
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Telephone | 414-346-0276
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Fax | 414-600-6206
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Provider Business Mailing Address
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Address Line | 3612 WEST NORTH AVENUE
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City | MILWAUKEE
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State | WI
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Zip | 53208
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Country | US
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Telephone | 414-346-0276
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Fax | 414-600-6206
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Authorized Official
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Title or Position | ADMINISTRATOR /OWNER
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Name | SHAJUAN KENNEDY
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Credential | LPC
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Telephone | 414-346-0276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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