Provider Demographics
NPI:1912261447
Name:KENNEL, COURTNEY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:KENNEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5920 100TH ST SW
Mailing Address - Street 2:SUITE 26C
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-830-2030
Mailing Address - Fax:253-830-2055
Practice Address - Street 1:5920 100TH ST SW
Practice Address - Street 2:SUITE 31
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-584-3023
Practice Address - Fax:253-582-1222
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60413256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine