Provider Demographics
NPI:1437810884
Name:KENNEALEY, SHANNON L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:KENNEALEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CHARLOU CIR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILLS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1103
Mailing Address - Country:US
Mailing Address - Phone:720-242-7515
Mailing Address - Fax:
Practice Address - Street 1:5340 S QUEBEC ST STE 330
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1909
Practice Address - Country:US
Practice Address - Phone:773-320-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099273821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical