Doctor Name: | DR. JAN ELIZABETH KENNEDY |
NPI Number: | 1235117508 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 24866 |
Business Practice Address: | 2200 Bergquist Dr Suite 1 Attn: Credentials (cmc) Lackland A F B, TX - 782369907 |
Business Phone Number: | 2102927230 |
Business Fax Number: | 2102922029 |
Mailing Address: | 15530 Elm Park St, SAN ANTONIO |
State: | TX |
Postal Code: | 782472905 |
Phone Number: | 2104949599 |
Fax Number: | 2104817777 |
NPI Enumeration Date: | 01/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 24866 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |