Provider Demographics
NPI:1992680573
Name:KENNEDY, JESSIE ANN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32346 245TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52626-8002
Mailing Address - Country:US
Mailing Address - Phone:319-470-7111
Mailing Address - Fax:
Practice Address - Street 1:709 1ST ST
Practice Address - Street 2:
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565-7756
Practice Address - Country:US
Practice Address - Phone:319-470-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health