Provider Demographics
NPI:1235827478
Name:KENNEDY, THERESA MAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MAE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 BALKAN PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-5002
Mailing Address - Country:US
Mailing Address - Phone:419-936-0084
Mailing Address - Fax:
Practice Address - Street 1:1958 BALKAN PL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-5002
Practice Address - Country:US
Practice Address - Phone:419-936-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.174205251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care