Provider Demographics
NPI:1558147587
Name:LEUTENEGGER, KENNEDY ELAINE (LPC)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:ELAINE
Last Name:LEUTENEGGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CROGHAN STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2337
Mailing Address - Country:US
Mailing Address - Phone:419-458-3100
Mailing Address - Fax:567-250-2152
Practice Address - Street 1:915 CROGHAN STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2337
Practice Address - Country:US
Practice Address - Phone:419-458-3100
Practice Address - Fax:567-250-2152
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCT.2305026-TRNE101Y00000X
OH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor