Provider Demographics
NPI:1891453775
Name:KENNEDY, PRECIOUS MYESHA
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:MYESHA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9129 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-1703
Mailing Address - Country:US
Mailing Address - Phone:414-213-7758
Mailing Address - Fax:
Practice Address - Street 1:9129 N SWAN RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-1703
Practice Address - Country:US
Practice Address - Phone:414-213-7758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management