Provider Demographics
NPI:1932776564
Name:KENNEDY, LAYKENN (LADAC)
Entity Type:Individual
Prefix:
First Name:LAYKENN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-3034
Mailing Address - Country:US
Mailing Address - Phone:505-326-7878
Mailing Address - Fax:
Practice Address - Street 1:6100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-3034
Practice Address - Country:US
Practice Address - Phone:505-326-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)