Provider Demographics
NPI:1447380753
Name:KINNAIRD, JOHN R (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KINNAIRD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 SHEELY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1939
Mailing Address - Country:US
Mailing Address - Phone:970-305-5260
Mailing Address - Fax:
Practice Address - Street 1:420 S HOWES ST # B100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2871
Practice Address - Country:US
Practice Address - Phone:970-305-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66620554Medicaid