Provider Demographics
NPI:1114225299
Name:TRENKAMP, KENNA K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENNA
Middle Name:K
Last Name:TRENKAMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 CHALAN PALOSYO
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96910-6427
Mailing Address - Country:US
Mailing Address - Phone:671-788-9243
Mailing Address - Fax:
Practice Address - Street 1:498 CHALAN PALOSYO
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910-6427
Practice Address - Country:US
Practice Address - Phone:671-475-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW006102OtherLICENSE