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General NPI Number Information
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NPI Number | 1861973083
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Entity Type | Individual
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Provider Name | SHA'JUAN KENNEDY
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Gender | Female
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 13035 W BLUEMOUND RD STE 100
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City | BROOKFIELD
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State | WI
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Zip | 53005-8001
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Country | US
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Telephone | 262-408-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 401 W MICHIGAN ST APT 412
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City | MILWAUKEE
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State | WI
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Zip | 53203-2815
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Country | US
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Telephone | 414-399-8736
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7602125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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