Provider Demographics
NPI:1477843514
Name:KENNEDY, JAMIE NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SHADY GRV
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65063-1429
Mailing Address - Country:US
Mailing Address - Phone:573-874-8686
Mailing Address - Fax:573-874-8608
Practice Address - Street 1:4304 S BEARFIELD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9557
Practice Address - Country:US
Practice Address - Phone:573-874-8686
Practice Address - Fax:573-874-8608
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional