MEDICARE: MISS DELLA KENNEDY

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1689963274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DELLA KENNEDY

Provider Business Mailing Address
First Line	:	3752 BOSSA NOVA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6800
Country	:	US
Telephone Number	:	702-542-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3752 BOSSA NOVA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6800
Country	:	US
Telephone Number	:	702-542-1300
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	06/28/2013

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Directions to “ MISS DELLA KENNEDY ” Practice Location

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