Provider Demographics
NPI:1205170958
Name:KENNEDY, HOLLY (MSW, CSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-9466
Mailing Address - Country:US
Mailing Address - Phone:605-430-2253
Mailing Address - Fax:605-348-1050
Practice Address - Street 1:5700 W ELM ST
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:SD
Practice Address - Zip Code:57718-9466
Practice Address - Country:US
Practice Address - Phone:605-430-2253
Practice Address - Fax:605-348-1050
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD34041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical