Provider Demographics
NPI:1093143158
Name:KENNEDY, PAMELA KATE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KATE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2701
Mailing Address - Country:US
Mailing Address - Phone:307-674-4406
Mailing Address - Fax:307-673-5167
Practice Address - Street 1:1221 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2701
Practice Address - Country:US
Practice Address - Phone:307-674-4405
Practice Address - Fax:307-673-5167
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-5661041C0700X
WYPCSW 7181041C0700X
171M00000X
WY11751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator