MEDICARE: AMY KENNAUGH

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

General Provider Information

NPI Number	:	1407454341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY KENNAUGH

Provider Business Mailing Address
First Line	:	116 7TH ST NW STE 201
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2400
Country	:	US
Telephone Number	:	234-209-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 7TH ST NW STE 201
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2400
Country	:	US
Telephone Number	:	234-209-9686
Fax Number	:

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

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	03/12/2026

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