Provider Demographics
NPI:1871894105
Name:KENNEDY, JERI LYN (LSCSW)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:LYN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:LYN
Other - Last Name:KENNEDY-LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:839 N PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3139
Mailing Address - Country:US
Mailing Address - Phone:316-512-1786
Mailing Address - Fax:
Practice Address - Street 1:839 N PERRY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3139
Practice Address - Country:US
Practice Address - Phone:316-512-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220419351041C0700X
KS18691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical