Provider Demographics
NPI:1235609884
Name:WARD, ELIZABETH KENNEDY
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KENNEDY
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LEE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:18300 MINNETONKA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4151
Mailing Address - Country:US
Mailing Address - Phone:952-222-4284
Mailing Address - Fax:
Practice Address - Street 1:18300 MINNETONKA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4151
Practice Address - Country:US
Practice Address - Phone:952-222-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6461103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist