Individual
DANA MARIE KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2400 47TH AVE S, GRAND FORKS, ND 58201-3405
(701) 215-5906
Mailing address
2400 47TH AVE S, GRAND FORKS, ND 58201-3405
(701) 746-2200
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
3547
ND
1041C0700X
Clinical Social Worker
Primary
3547
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027884
BCBS PROVIDER NUMBER
ND
05
—
054519
—
ND
Enumeration date
11/08/2006
Last updated
09/09/2024
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