Provider Demographics
NPI:1972689933
Name:KINNEY, KENDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-3527
Mailing Address - Country:US
Mailing Address - Phone:970-856-6970
Mailing Address - Fax:970-856-7752
Practice Address - Street 1:195 WEST MAIN
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413
Practice Address - Country:US
Practice Address - Phone:970-856-6970
Practice Address - Fax:970-856-7752
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9910781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO035353Medicaid