Provider Demographics
NPI:1750914339
Name:KENNEDY, KALEE
Entity type:Individual
Prefix:
First Name:KALEE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WASHINGTON STATE UNIVERSITY
Mailing Address - Street 2:160 CLEVELAND HALL PO BOX 642114 1155 COLLEGE AVE
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON STATE UNIVERSITY
Practice Address - Street 2:160 CLEVELAND HALL 1155 COLLEGE AVE
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164
Practice Address - Country:US
Practice Address - Phone:509-335-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer