Provider Demographics
NPI:1477671469
Name:KENNEALLY, KATHLEEN ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:KENNEALLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27225 CAMP PLENTY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2654
Mailing Address - Country:US
Mailing Address - Phone:661-252-4100
Mailing Address - Fax:661-252-4106
Practice Address - Street 1:27225 CAMP PLENTY ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2654
Practice Address - Country:US
Practice Address - Phone:661-252-4100
Practice Address - Fax:661-252-4106
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC7815171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist