Provider Demographics
NPI:1528600145
Name:KENYON, NATALIE J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:J
Last Name:KENYON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N 2ND ST APT 120
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-3307
Mailing Address - Country:US
Mailing Address - Phone:612-428-0043
Mailing Address - Fax:651-846-4899
Practice Address - Street 1:600 N 2ND ST APT 120
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401
Practice Address - Country:US
Practice Address - Phone:612-428-0043
Practice Address - Fax:651-846-4899
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN182551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical