Provider Demographics
NPI:1326197161
Name:KENNEDY, ERIN K (CADC, LMSW)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:K
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CADC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-1628
Mailing Address - Country:US
Mailing Address - Phone:515-233-2250
Mailing Address - Fax:515-233-3235
Practice Address - Street 1:125 S 3RD ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-7042
Practice Address - Country:US
Practice Address - Phone:515-233-2250
Practice Address - Fax:515-233-3235
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01017101YA0400X
IA008197104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker