Provider Demographics
NPI:1356981245
Name:KENNEDY, RACHEL MARY (LCPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARY
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:11 N NORTHWEST HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3452
Mailing Address - Country:US
Mailing Address - Phone:901-262-4882
Mailing Address - Fax:
Practice Address - Street 1:11 N NORTHWEST HWY STE 114
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3452
Practice Address - Country:US
Practice Address - Phone:901-262-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional