Provider Demographics
NPI:1033821038
Name:KENNAW, JORDAN (RBT)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:KENNAW
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FRIEDBERG CHURCH RD # NA
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9803
Mailing Address - Country:US
Mailing Address - Phone:336-251-1180
Mailing Address - Fax:336-251-1018
Practice Address - Street 1:905 FRIEDBERG CHURCH RD # NA
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9803
Practice Address - Country:US
Practice Address - Phone:336-251-1180
Practice Address - Fax:336-251-1018
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician