Provider Demographics
NPI:1881985372
Name:KELLOGG, ANNETTE KENNEDY (MED, LPC, NCC, RPT/S)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:KENNEDY
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MED, LPC, NCC, RPT/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1699 STROZIER RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8236
Mailing Address - Country:US
Mailing Address - Phone:318-381-4111
Mailing Address - Fax:318-396-1004
Practice Address - Street 1:1699 STROZIER RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8236
Practice Address - Country:US
Practice Address - Phone:318-381-4111
Practice Address - Fax:318-396-1004
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional