Individual
MR. OWEN C KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1807 N CENTER ST, BEAVER DAM, WI 53916-1001
(920) 887-8751
Mailing address
7110 TREE LN, MADISON, WI 53717-1518
(608) 203-5502
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
7677-125
WI
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
03/09/2016
Last updated
03/07/2024
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