MEDICARE: KRISTEN KENNEDY MA, LPC, NCC

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	101Y00000X	Counselor		MI

General Provider Information

NPI Number	:	1902391733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN KENNEDY MA, LPC, NCC

Provider Business Mailing Address
First Line	:	987 S SANDALWOOD CIR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5998
Country	:	US
Telephone Number	:	616-638-4078
Fax Number	:

Provider Business Practice Location Address
First Line	:	4265 GRAND HAVEN RD STE 106
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5546
Country	:	US
Telephone Number	:	616-638-4078
Fax Number	:

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

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	01/26/2021

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