Provider Demographics
NPI:1619000882
Name:KENNEALLY, SUZANNE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:KENNEALLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S. PIERCE STREET
Mailing Address - Street 2:SUITE 386
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128
Mailing Address - Country:US
Mailing Address - Phone:303-960-9291
Mailing Address - Fax:303-265-9409
Practice Address - Street 1:6901 S. PIERCE STREET
Practice Address - Street 2:SUITE 386
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128
Practice Address - Country:US
Practice Address - Phone:303-960-9291
Practice Address - Fax:303-265-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1793103G00000X, 103T00000X
COCO1793103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist