Provider Demographics
NPI:1811053481
Name:KENNEDY, BARBARA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3499
Mailing Address - Country:US
Mailing Address - Phone:515-292-1813
Mailing Address - Fax:515-826-4369
Practice Address - Street 1:113 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3499
Practice Address - Country:US
Practice Address - Phone:515-292-1813
Practice Address - Fax:515-826-4369
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health