Provider Demographics
NPI:1376270264
Name:SLOAN, KENNA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:MICHELLE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIMSTONE HILL RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:EPSOM
Mailing Address - State:NH
Mailing Address - Zip Code:03234-4001
Mailing Address - Country:US
Mailing Address - Phone:603-717-6488
Mailing Address - Fax:603-676-7537
Practice Address - Street 1:4 BRIMSTONE HILL RD UNIT 1
Practice Address - Street 2:
Practice Address - City:EPSOM
Practice Address - State:NH
Practice Address - Zip Code:03234-4001
Practice Address - Country:US
Practice Address - Phone:603-717-6488
Practice Address - Fax:603-676-7537
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty