MEDICARE: MISS KENNEDY ALISE WILLIAMS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1447029038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KENNEDY ALISE WILLIAMS

Provider Business Mailing Address
First Line	:	4811 DOUGLAS RD APT 21
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-3272
Country	:	US
Telephone Number	:	734-444-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 N ERIE ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1949
Country	:	US
Telephone Number	:	734-444-1221
Fax Number	:

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

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	06/06/2024

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Directions to “ MISS KENNEDY ALISE WILLIAMS ” Practice Location

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