Provider Demographics
NPI:1629198999
Name:BRIGGS, KENN (LCSW)
Entity Type:Individual
Prefix:
First Name:KENN
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N TEJON ST STE 19
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1251
Mailing Address - Country:US
Mailing Address - Phone:719-650-4000
Mailing Address - Fax:
Practice Address - Street 1:313 N TEJON ST STE 19
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1251
Practice Address - Country:US
Practice Address - Phone:719-650-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA101574Medicaid