Provider Demographics
NPI:1093403602
Name:KENNY, VALERIE ANDREA (CAS)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANDREA
Last Name:KENNY
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANDREA
Other - Last Name:LOCASCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1644 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1007
Mailing Address - Country:US
Mailing Address - Phone:970-221-0999
Mailing Address - Fax:970-221-2727
Practice Address - Street 1:1644 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1007
Practice Address - Country:US
Practice Address - Phone:970-221-0999
Practice Address - Fax:970-221-2727
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1060320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness