Provider Demographics
NPI:1023030400
Name:KENNAUGH, BROOKE ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:KENNAUGH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041-112TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:206-930-4930
Mailing Address - Fax:208-733-7178
Practice Address - Street 1:1800 WESTLAKE AVE NORTH
Practice Address - Street 2:SUITE 105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:208-733-7186
Practice Address - Fax:208-733-7178
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional