Provider Demographics
NPI:1447142625
Name:KENNEDY, BROOKLYNN CHEYENNE
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:CHEYENNE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIO
Other - Middle Name:CHEYENNE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1845 S FERRY ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2160
Mailing Address - Country:US
Mailing Address - Phone:612-544-0372
Mailing Address - Fax:
Practice Address - Street 1:1845 S FERRY ST APT 203
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2160
Practice Address - Country:US
Practice Address - Phone:612-544-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician