Provider Demographics
NPI:1982758587
Name:KEENAN, KATHLEEN JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOY
Last Name:KEENAN
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 1:4200 SOMERSET DR STE 254
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5213
Mailing Address - Country:US
Mailing Address - Phone:913-648-1870
Mailing Address - Fax:913-491-8448
Practice Address - Street 1:4200 SOMERSET DR STE 254
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5213
Practice Address - Country:US
Practice Address - Phone:913-648-1870
Practice Address - Fax:913-491-8448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS994103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0008125Medicare ID - Type Unspecified