Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | B1-0000440 | DE |
N | 103TC0700X | Clinical Psychologist | B1-0000440 | DE |
Y | 103G00000X | Clinical Psychologist | B1-0000440 | DE |
Y | 103TC0700X | Clinical Psychologist | B1-0000440 | DE |
NPI | 1003944760 |
---|---|
Provider Name | Dr. Kerri Janine Kennard |
First Address | Seaford, DE 19973-0576 |
Second Address | Seaford, DE 19973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000037339 | (05) | DE |
100035675 | DPCI PIN (01) | DE |