Provider Demographics
NPI:1336460112
Name:KENNARD, DEBORAH S (MS, LLP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:S
Last Name:KENNARD
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5337
Mailing Address - Country:US
Mailing Address - Phone:734-925-3622
Mailing Address - Fax:734-929-2433
Practice Address - Street 1:1205 MEADOWBROOK ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5337
Practice Address - Country:US
Practice Address - Phone:734-925-3622
Practice Address - Fax:734-929-2433
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical