Provider Demographics
NPI:1316261167
Name:KENNETH L HENNEFER AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:KENNETH L HENNEFER AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENNEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:801-352-2844
Mailing Address - Street 1:7321 S STATE ST
Mailing Address - Street 2:SUITE AB
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2055
Mailing Address - Country:US
Mailing Address - Phone:801-352-2844
Mailing Address - Fax:801-942-1973
Practice Address - Street 1:7321 S STATE ST
Practice Address - Street 2:SUITE AB
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2055
Practice Address - Country:US
Practice Address - Phone:801-352-2844
Practice Address - Fax:801-942-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000007101Medicare UPIN