Provider Demographics
NPI:1881754869
Name:KENNEY, JAMIE KAY (PHD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAY
Last Name:KENNEY
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 1:2560 S ROWEN
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4970
Mailing Address - Country:US
Mailing Address - Phone:480-518-6040
Mailing Address - Fax:
Practice Address - Street 1:1155 S POWER RD STE 11496
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3715
Practice Address - Country:US
Practice Address - Phone:480-518-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CO3614103TC0700X
TX37581103TC0700X
AZ004286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist