Provider Demographics
NPI:1962501692
Name:KENNEDY, KARI LEE (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:LEE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1364
Mailing Address - Country:US
Mailing Address - Phone:317-807-0456
Mailing Address - Fax:866-788-3791
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1364
Practice Address - Country:US
Practice Address - Phone:317-807-0456
Practice Address - Fax:866-788-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041821A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000327281OtherANTHEM INSURANCE