Provider Demographics
NPI:1619646114
Name:KENNY, CHRISTIN RACHEL
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:RACHEL
Last Name:KENNY
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 1:2875 LONGFELLOW PL APT 343
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7481
Mailing Address - Country:US
Mailing Address - Phone:541-221-0225
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3871
Practice Address - Country:US
Practice Address - Phone:541-686-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker