Provider Demographics
NPI:1295268647
Name:BENNETT, KANDI SUE (CSW)
Entity type:Individual
Prefix:MS
First Name:KANDI
Middle Name:SUE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 DEMOCRAT DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9214
Mailing Address - Country:US
Mailing Address - Phone:859-209-2370
Mailing Address - Fax:502-352-2706
Practice Address - Street 1:251 DEMOCRAT DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-9214
Practice Address - Country:US
Practice Address - Phone:859-209-2370
Practice Address - Fax:502-352-2706
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252475101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)