Provider Demographics
NPI:1447270012
Name:KENNEDY, LEANNE ELIZABETH (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:ELIZABETH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 HARBOR VIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1848
Mailing Address - Country:US
Mailing Address - Phone:253-927-9254
Mailing Address - Fax:
Practice Address - Street 1:4930 HARBOR VIEW DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1848
Practice Address - Country:US
Practice Address - Phone:253-927-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALHOOOO6016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALHOOOO6016OtherMENTAL HEALTH COUNSELOR