Individual
CHARLOTTE KENNERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDEPENDENT PROVIDER
Contact information
Practice address
16912 GLENDALE AVE, CLEVELAND, OH 44128-1554
(216) 965-3460
Mailing address
16912 GLENDALE AVE, CLEVELAND, OH 44128-1554
(216) 965-3460
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
1831304
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831304
—
OH
Enumeration date
12/28/2020
Last updated
12/28/2020
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