Provider Demographics
NPI:1386816395
Name:KENNEDY KRIEGER EDUCATION AND COMMUNICATION
Entity Type:Organization
Organization Name:KENNEDY KRIEGER EDUCATION AND COMMUNICATION
Other - Org Name:KENNEDY KRIEGER SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-923-1810
Mailing Address - Street 1:P. O. BOX 744865
Mailing Address - Street 2:PATIENT ACCOUNTING HELENA PORTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374
Mailing Address - Country:US
Mailing Address - Phone:443-923-1886
Mailing Address - Fax:443-923-1895
Practice Address - Street 1:1311 N. GILMOR ST.
Practice Address - Street 2:GILMORE SCHOOL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217
Practice Address - Country:US
Practice Address - Phone:410-462-2700
Practice Address - Fax:443-923-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041S0200X, 163WC0400X, 225100000X, 225X00000X, 235Z00000X
MD30-036261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1754815 02Medicaid