Provider Demographics
NPI:1225331663
Name:KENNEDY, ANN MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:MCILROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-S
Mailing Address - Street 1:1070 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2374
Mailing Address - Country:US
Mailing Address - Phone:614-309-1576
Mailing Address - Fax:614-921-0948
Practice Address - Street 1:1070 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2374
Practice Address - Country:US
Practice Address - Phone:614-309-1576
Practice Address - Fax:614-921-0948
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00094451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical