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NPI Code Detail

MEDICARE: KENNEDY JENNINGS

MEDICARE: KENNEDY JENNINGS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1205791779
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY JENNINGS
Provider Business Mailing Address
First Line : 5588 N PALM AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-314-1128
Fax Number :
Provider Business Practice Location Address
First Line : 5588 N PALM AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-314-1128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2025
Last Update Date : 12/17/2025

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Directions to “ KENNEDY JENNINGS ” Practice Location

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