Provider Demographics
NPI:1770681041
Name:KENNEDY, KARIN ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 W LOCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9351
Mailing Address - Country:US
Mailing Address - Phone:517-279-8123
Mailing Address - Fax:
Practice Address - Street 1:298 W LOCKWOOD RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9351
Practice Address - Country:US
Practice Address - Phone:517-279-8123
Practice Address - Fax:517-278-6672
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801066410104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS57654Medicare UPIN
MID16222078Medicare ID - Type UnspecifiedMEDICARE