Provider Demographics
NPI:1205376787
Name:KENNEDY, EMILY (LMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9372
Mailing Address - Country:US
Mailing Address - Phone:248-345-5933
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 160
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2357
Practice Address - Country:US
Practice Address - Phone:734-929-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011162271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical