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NPI Code Detail

MEDICARE: KENNEDY WILLEMARCK

MEDICARE: KENNEDY WILLEMARCK
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
1104100000XSocial Worker32169MN

General Provider Information

NPI Number : 1467316877
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY WILLEMARCK
Provider Business Mailing Address
First Line : 5125 COUNTY ROAD 101 STE 300
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4157
Country : US
Telephone Number : 952-932-7277
Fax Number : 952-932-9827
Provider Business Practice Location Address
First Line : 5125 COUNTY ROAD 101 STE 300
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4157
Country : US
Telephone Number : 952-932-7277
Fax Number : 952-932-9827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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Directions to “ KENNEDY WILLEMARCK ” Practice Location

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