Most Relevant Information
Provider Data
NPI Number: | 1003474784 |
Provider Name: | KELLY KENNEDY |
Entity Type: | Individual |
Taxonomy Code: | 101YM0800X |
Specialty: | Counselor |
License Number: |
Most Important Dates
Enumeration Date: | 05/29/2019 |
Last Updated: | 06/20/2024 |
Provider Practice Location
236 MOULTRIE PL
SANTA PAULA
CA
930603241
Practice Location Phone/Fax
Phone: | 8058508632 |
Fax: | 8055660298 |
Provider Mailing Location
236 MOULTRIE PL
SANTA PAULA
CA
930603241
Provider Mailing Phone/Fax
Phone: | 8058508632 |
Fax: | 8055660298 |