Individual
CANDICE KENNERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 PALM COAST PKWY SW STE 103, PALM COAST, FL 32137-4743
(386) 225-4940
Mailing address
1 BLAINE DR, PALM COAST, FL 32137-7324
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-69822
FL
106E00000X
Assistant Behavior Analyst
0-19-9711
FL
Other
Enumeration date
07/22/2019
Last updated
03/20/2025
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