Provider Demographics
NPI:1063219186
Name:DABNEY, KENNETH WARD III
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WARD
Last Name:DABNEY
Suffix:III
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:WARD
Other - Last Name:DABNEY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PRS
Mailing Address - Street 1:14445 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1957
Mailing Address - Country:US
Mailing Address - Phone:216-677-8177
Mailing Address - Fax:
Practice Address - Street 1:14445 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-1957
Practice Address - Country:US
Practice Address - Phone:216-677-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005812175T00000X
OHCDCA.192063171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist