Provider Demographics
NPI:1669843256
Name:KENNON, SHERYL ELIZABETH (BS)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ELIZABETH
Last Name:KENNON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:SHERYL
Other - Middle Name:ELIZABETH
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16506 SE 29TH ST APT K101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-2358
Mailing Address - Country:US
Mailing Address - Phone:360-449-9149
Mailing Address - Fax:
Practice Address - Street 1:9300 NE OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6192
Practice Address - Country:US
Practice Address - Phone:360-567-2211
Practice Address - Fax:360-567-2212
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator