Provider Demographics
NPI:1891553657
Name:KENNEDY, KAITLIN ANN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
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 1:2921 W 120TH AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2944
Mailing Address - Country:US
Mailing Address - Phone:888-528-3860
Mailing Address - Fax:
Practice Address - Street 1:2921 W 120TH AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2944
Practice Address - Country:US
Practice Address - Phone:888-528-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator