Provider Demographics
NPI:1558147587
Name:LEUTENEGGER, KENNEDY ELAINE
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:ELAINE
Last Name:LEUTENEGGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1937
Mailing Address - Country:US
Mailing Address - Phone:419-734-5535
Mailing Address - Fax:
Practice Address - Street 1:304 MADISON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1937
Practice Address - Country:US
Practice Address - Phone:419-734-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCT.2305026-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor