Provider Demographics
NPI:1558799429
Name:KENNETT, JENNIFER S (MA, MBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:KENNETT
Suffix:
Gender:F
Credentials:MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 BEL RED RD STE 102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5507
Mailing Address - Country:US
Mailing Address - Phone:425-406-8627
Mailing Address - Fax:
Practice Address - Street 1:15446 BEL RED RD STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5507
Practice Address - Country:US
Practice Address - Phone:425-406-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60516584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health