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NPI Code Detail

MEDICARE: WENDY KENNEDY MA

MEDICARE: WENDY KENNEDY MA
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
1101YM0800XMental Health CounselorLPC-0037AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LPC-0037OTHERAZSTATE

General Provider Information

NPI Number : 1639329410
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY KENNEDY MA
Provider Business Mailing Address
First Line : 404 W AERO DR
Second Line :
City : PAYSON
State : AZ
Zip : 85541-5407
Country : US
Telephone Number : 928-474-3303
Fax Number :
Provider Business Practice Location Address
First Line : 3450 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2331
Country : US
Telephone Number : 602-265-8338
Fax Number : 602-265-8574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 10/30/2008

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