Provider Demographics
NPI:1437809522
Name:PARON, KENNEDY L (MA ED, 5/ 9 DBH,BS)
Entity Type:Individual
Prefix:MRS
First Name:KENNEDY
Middle Name:L
Last Name:PARON
Suffix:
Gender:F
Credentials:MA ED, 5/ 9 DBH,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8542 W GRAND RIVER AVE # R
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2326
Mailing Address - Country:US
Mailing Address - Phone:173-444-9464
Mailing Address - Fax:
Practice Address - Street 1:IVY REHAB FOR KIDS
Practice Address - Street 2:8542 WEST GRAND RIVER
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician