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 |