Provider Demographics
NPI:1720323819
Name:KENNEDY HERRMANN & ASSOCIATES LLC
Entity Type:Organization
Organization Name:KENNEDY HERRMANN & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEDY HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:219-393-9033
Mailing Address - Street 1:PO BOX 10126
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0126
Mailing Address - Country:US
Mailing Address - Phone:219-769-2141
Mailing Address - Fax:219-769-2675
Practice Address - Street 1:7863 BROADWAY STE 236
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5554
Practice Address - Country:US
Practice Address - Phone:219-769-2141
Practice Address - Fax:219-769-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006146A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000801843OtherANTHEM BS