Individual
THERESA ANN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
1115 IRONWOOD DRIVE, COEUR D ALENE, ID 83814-4936
(208) 765-0955
(208) 765-6972
Mailing address
PO BOX 1356, COEUR D ALENE, ID 83816-1356
(208) 765-0955
(208) 765-6972
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW27132
ID
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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