Provider Demographics
NPI:1649902685
Name:KENNELL, AARON JOSHUA (LGSW)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JOSHUA
Last Name:KENNELL
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 BRYANT AVE S APT 3
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1775
Mailing Address - Country:US
Mailing Address - Phone:321-402-3180
Mailing Address - Fax:
Practice Address - Street 1:1303 S FRONTAGE RD STE 221
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2688
Practice Address - Country:US
Practice Address - Phone:224-424-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN309531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical