Provider Demographics
NPI:1932806825
Name:BARNETT, KENNETH A
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 LOUISIANA AVE PERRYSBURG OH
Mailing Address - Street 2:APT 1
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:419-304-5487
Mailing Address - Fax:
Practice Address - Street 1:219 LOUISIANA AVE PERRYSBURG OH
Practice Address - Street 2:APT 1
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-304-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty