MEDICARE: MS. BARBARA ANN KENNEDY LMSW

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	101YM0800X	Mental Health Counselor	7169	OK

General Provider Information

NPI Number	:	1386220713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA ANN KENNEDY LMSW

Provider Business Mailing Address
First Line	:	6327 GLENBROOK CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2179
Country	:	US
Telephone Number	:	602-622-1078
Fax Number	:

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

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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