Provider Demographics
NPI:1790859700
Name:KENNEDY-IWAI, RUTH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:KENNEDY-IWAI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 N 7TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1839
Mailing Address - Country:US
Mailing Address - Phone:602-684-8486
Mailing Address - Fax:602-274-0141
Practice Address - Street 1:6232 N 7TH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1839
Practice Address - Country:US
Practice Address - Phone:602-684-8486
Practice Address - Fax:602-274-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1944103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPHD1944BMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #