Provider Demographics
NPI:1043660517
Name:KENNING, MARY KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:KENNING
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:5100 EDEN AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2337
Mailing Address - Country:US
Mailing Address - Phone:952-929-9934
Mailing Address - Fax:612-869-8872
Practice Address - Street 1:5100 EDEN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2337
Practice Address - Country:US
Practice Address - Phone:952-929-9934
Practice Address - Fax:612-869-8872
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 0886103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic