Individual
SHALENE ANN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2040 WOODWINDS DR, WOODBURY, MN 55125-2522
(651) 259-9750
(651) 259-9790
Mailing address
2040 WOODWINDS DR, WOODBURY, MN 55125-2522
(651) 259-9750
(651) 259-9790
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
38890
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1561501
MEDICA
MN
05
—
951485600
—
MN
01
—
991N6KE
BCBS OF MN
MN
Enumeration date
12/14/2005
Last updated
11/22/2023
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