Individual
KELLY KENNEALY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
217 CATHERINE AVE, FERGUSON, MO 63135-2705
(314) 650-2820
Mailing address
217 CATHERINE AVE, FERGUSON, MO 63135-2705
(314) 650-2820
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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