Individual
MS. MICHELLE L. KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW-CSW-QMHP
Contact information
Practice address
11 EAST 4TH STREET, LEMMON, SD 57638-0447
(605) 374-3862
(605) 374-3864
Mailing address
P.O. BOX 447, LEMMON, SD 57638-0447
(605) 374-3862
(605) 374-3864
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1948
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003226
BCBS THREE RIVERS GROUP #
SD
01
—
4994184
BCBS PROVIDER #
SD
Enumeration date
12/29/2006
Last updated
07/08/2007
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