| Doctor Name: | MICHAEL SHAWN KENNEDY |
| NPI Number: | 1306116066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SCHOOL PSYCHOLOGIST |
| License Number: | 344005 |
| Business Practice Address: | 113 Hawk Dr Dulce, NM - 87528 |
| Business Phone Number: | 5757593225 |
| Business Fax Number: | 5757593533 |
| Mailing Address: | 113 Hawks Dr, DULCE |
| State: | NM |
| Postal Code: | 87528 |
| Phone Number: | 5757593225 |
| Fax Number: | 5757593533 |
| NPI Enumeration Date: | 01/11/2012 |
| NPI Last Update Date: | 01/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 344005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |