| Doctor Name: | WANDA MARIE KENNEL |
| NPI Number: | 1144278714 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCDC, LSBW |
| License Number: | 5922 |
| Business Practice Address: | 6563 Highland Rd Gilmer, TX - 756458279 |
| Business Phone Number: | 9037345592 |
| Business Fax Number: | |
| Mailing Address: | 6563 Highland Rd, GILMER |
| State: | TX |
| Postal Code: | 756458279 |
| Phone Number: | 9037345592 |
| Fax Number: | |
| NPI Enumeration Date: | 05/05/2006 |
| NPI Last Update Date: | 09/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 5922 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |