Provider Demographics
NPI:1386052942
Name:ENG, KELSEY KENNEDY (PSYD)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:KENNEDY
Last Name:ENG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:619 N 35TH ST # 313
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8868
Mailing Address - Country:US
Mailing Address - Phone:425-429-2205
Mailing Address - Fax:206-547-5298
Practice Address - Street 1:619 N 35TH ST # 313
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8868
Practice Address - Country:US
Practice Address - Phone:425-429-2205
Practice Address - Fax:206-547-5298
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60344343101YM0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health