Provider Demographics
NPI:1740737980
Name:KENNEDY, SARAH ANN (BA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:KORNEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31207 KEATS WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2219
Mailing Address - Country:US
Mailing Address - Phone:303-432-5365
Mailing Address - Fax:303-432-5350
Practice Address - Street 1:31207 KEATS WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2219
Practice Address - Country:US
Practice Address - Phone:303-432-5365
Practice Address - Fax:303-432-5350
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health