Provider Demographics
NPI:1093064008
Name:KENEVAN, JEANNINE (COMS, LPC)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:KENEVAN
Suffix:
Gender:F
Credentials:COMS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W COLLEGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5286
Mailing Address - Country:US
Mailing Address - Phone:920-831-2090
Mailing Address - Fax:920-831-2091
Practice Address - Street 1:820 W COLLEGE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5286
Practice Address - Country:US
Practice Address - Phone:920-831-2090
Practice Address - Fax:920-831-2091
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind