Provider Demographics
NPI:1285803841
Name:KENNEDY, SARAH MARGARET (LAC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARGARET
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:CEDAR
Other - Middle Name:S
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:6601 W DESCHUTES AVE STE D
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7811
Mailing Address - Country:US
Mailing Address - Phone:509-460-1286
Mailing Address - Fax:
Practice Address - Street 1:100 N MORAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2905
Practice Address - Country:US
Practice Address - Phone:509-460-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
WAAC00002931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC 00002931OtherWASHINGTON STATE LICENSE