Provider Demographics
NPI:1316131915
Name:KENNEDY, JENNIFER L (LSCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1106
Mailing Address - Country:US
Mailing Address - Phone:913-826-3150
Mailing Address - Fax:913-826-3136
Practice Address - Street 1:4850 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1106
Practice Address - Country:US
Practice Address - Phone:913-826-3150
Practice Address - Fax:913-826-3136
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44231041C0700X
MO2011022077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker