Provider Demographics
NPI:1467537027
Name:KENNEDY, BARBARA ANN (BARBARA KENNEDY, LPC)
Entity Type:Individual
Prefix:MISS
First Name:BARBARA
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BARBARA KENNEDY, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 NE 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2840
Mailing Address - Country:US
Mailing Address - Phone:503-261-8131
Mailing Address - Fax:
Practice Address - Street 1:8383 NE SANDY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4948
Practice Address - Country:US
Practice Address - Phone:503-253-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health