Provider Demographics
NPI:1649575820
Name:KENNEDY, JOSHUA M (ST,XT,HCA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:ST,XT,HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21911 76TH AVE W
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7918
Mailing Address - Country:US
Mailing Address - Phone:425-778-2220
Mailing Address - Fax:425-778-7701
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:SUITE 106
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7918
Practice Address - Country:US
Practice Address - Phone:425-778-2220
Practice Address - Fax:425-778-7701
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAST60168312246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist