Provider Demographics
NPI:1073757498
Name:KENNEDY, LATESHA
Entity Type:Individual
Prefix:MRS
First Name:LATESHA
Middle Name:
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 1:4225 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3628
Mailing Address - Country:US
Mailing Address - Phone:214-821-6505
Mailing Address - Fax:214-821-6504
Practice Address - Street 1:2007 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1815
Practice Address - Country:US
Practice Address - Phone:717-232-7580
Practice Address - Fax:717-232-2357
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst