Provider Demographics
NPI:1346615960
Name:KENNEDY, ARTHUR (SACIT)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 N TEUTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3118
Mailing Address - Country:US
Mailing Address - Phone:414-739-1273
Mailing Address - Fax:414-540-9750
Practice Address - Street 1:6737 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3118
Practice Address - Country:US
Practice Address - Phone:414-540-9750
Practice Address - Fax:414-540-9750
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16608-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)