Provider Demographics
NPI:1841817517
Name:KENNEDY, NANCY ALICE (LPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ALICE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17211 SILVER MOUND LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8996
Mailing Address - Country:US
Mailing Address - Phone:708-508-5818
Mailing Address - Fax:
Practice Address - Street 1:17211 SILVER MOUND LN
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8996
Practice Address - Country:US
Practice Address - Phone:708-508-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional