Doctor Name: | DR. M. WAYNE KENNEDY |
NPI Number: | 1134271083 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 2005015539 |
Business Practice Address: | 445 E South St Ozark, MO - 657219406 |
Business Phone Number: | 4175810077 |
Business Fax Number: | 4175811220 |
Mailing Address: | 445 E South St, OZARK |
State: | MO |
Postal Code: | 657219406 |
Phone Number: | 4175810077 |
Fax Number: | 4175811220 |
NPI Enumeration Date: | 01/18/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2005015539 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |