Provider Demographics
NPI:1265448179
Name:KENNEDY, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-298-6735
Mailing Address - Fax:414-298-6737
Practice Address - Street 1:2323 N LAKE DR
Practice Address - Street 2:ATTN: SACRED HEART REHAB
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-298-6735
Practice Address - Fax:414-298-6737
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-06-11
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Provider Licenses
StateLicense IDTaxonomies
WI50594208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation