Provider Demographics
NPI:1679127146
Name:KENNEY, LESLIE CATHERINE (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:CATHERINE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1898
Mailing Address - Country:US
Mailing Address - Phone:307-754-6053
Mailing Address - Fax:
Practice Address - Street 1:231 W 6TH ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1898
Practice Address - Country:US
Practice Address - Phone:307-754-6053
Practice Address - Fax:307-754-6099
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer