Individual
CARRIE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISA
Contact information
Practice address
1634 SYCAMORE LINE, SANDUSKY, OH 44870-4132
(419) 626-9156
Mailing address
853 N MAIN ST, CLYDE, OH 43410-1215
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I.2405608
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340030752969
MEDICAL MUTUAL
OH
Enumeration date
09/26/2014
Last updated
08/19/2024
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