Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1316022015 |
---|---|
Provider Name | Dr. Maureen Carolyn Kennedy |
First Address | Plymouth, MN 55441-1909 |
Second Address | Minneapolis, MN 55417-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |