MEDICARE: MRS. MARLA CATHERINE KENNEDY MA LP LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LP 1248	MN
2	106H00000X	Marriage & Family Therapist	0666	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP36121	OTHER	MN	HEALTH PARTNERS OLD
2	0666	OTHER	MN	MARRIAGE AND FAMILY LICEN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	LP1248	OTHER	MN	PSYCHOLOGY LICENSE
5	BC 1GO74KE	OTHER	MN	BLUE CROSS

General Provider Information

NPI Number	:	1023238904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLA CATHERINE KENNEDY MA LP LMFT

Provider Business Mailing Address
First Line	:	2259 SUMMIT AVE.
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1002
Country	:	US
Telephone Number	:	651-645-3303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 EAST LAKE ST.
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2259
Country	:	US
Telephone Number	:	651-645-6020
Fax Number	:	651-645-6020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/11/2025

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