Provider Demographics
NPI:1447434477
Name:FLOYD-KENNETT, ELANA RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:RUTH
Last Name:FLOYD-KENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 DEVILS FORK RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-0504
Mailing Address - Country:US
Mailing Address - Phone:618-549-7741
Mailing Address - Fax:
Practice Address - Street 1:1007 ROUTE 45
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930
Practice Address - Country:US
Practice Address - Phone:618-273-7723
Practice Address - Fax:618-273-3384
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical