Provider Demographics
NPI:1558927806
Name:KENNEDY, MEGAN LEANN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEANN
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 1:27 S MANITOU AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1825
Mailing Address - Country:US
Mailing Address - Phone:248-245-2280
Mailing Address - Fax:
Practice Address - Street 1:27 S MANITOU AVE
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1825
Practice Address - Country:US
Practice Address - Phone:248-245-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical