Provider Demographics
NPI:1477991974
Name:KENNEDY, KATHERINE PATRICIA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PATRICIA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:PATRICIA
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1687 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1384
Mailing Address - Country:US
Mailing Address - Phone:508-397-4533
Mailing Address - Fax:
Practice Address - Street 1:1687 FARRINGTON DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1384
Practice Address - Country:US
Practice Address - Phone:508-397-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor