Provider Demographics
NPI:1336836220
Name:KENNEDY BEHAVIOR CONSULTING, PLLC
Entity Type:Organization
Organization Name:KENNEDY BEHAVIOR CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-424-3187
Mailing Address - Street 1:1320 S RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8363
Mailing Address - Country:US
Mailing Address - Phone:385-424-3187
Mailing Address - Fax:
Practice Address - Street 1:210 S 1970 E UNIT 238
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4720
Practice Address - Country:US
Practice Address - Phone:435-709-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty