Provider Demographics
NPI:1497992507
Name:KENNEDY, JENNIFER S (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2784 LAKE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8060
Mailing Address - Country:US
Mailing Address - Phone:614-230-7841
Mailing Address - Fax:
Practice Address - Street 1:2784 LAKE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8060
Practice Address - Country:US
Practice Address - Phone:614-230-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical