Provider Demographics
NPI:1750597514
Name:KENNEDY, FELICIA (PLPC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-7201
Mailing Address - Country:US
Mailing Address - Phone:573-579-4735
Mailing Address - Fax:
Practice Address - Street 1:815 N FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7201
Practice Address - Country:US
Practice Address - Phone:573-579-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional