Individual
DANIEL MICHAEL KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
(909) 580-2165
Mailing address
2779 28TH ST, HIGHLAND, CA 92346-1734
(503) 805-9465
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 32991
CA
Other
Enumeration date
07/29/2012
Last updated
03/18/2015
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