Provider Demographics
NPI:1487324182
Name:KENNEDY, ERIN KAY
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KAY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 SPANKER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8997
Mailing Address - Country:US
Mailing Address - Phone:479-301-8757
Mailing Address - Fax:
Practice Address - Street 1:701 N WALTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4548
Practice Address - Country:US
Practice Address - Phone:479-855-5704
Practice Address - Fax:479-268-4170
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1803021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor