Individual
TATIANA MARIE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
524 S 9TH AVE, CALDWELL, ID 83605-5075
(208) 454-8555
Mailing address
1224 W IVYWILD ST, BOISE, ID 83706-4514
(602) 552-1514
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/25/2025
Last updated
08/31/2025
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