| Heather Hart Kennedy, Lcsw, Llc | |
|
1110 N Old World 3rd St Ste 401 Milwaukee WI 53203-1117 | |
| (414) 224-0800 | |
| (414) 224-0883 |
| Full Name | Heather Hart Kennedy, Lcsw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1110 N Old World 3rd St Ste 401, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Heather Jean Hart Kennedy (OWNER) |
| Authorized Official Contact | 4146146299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Hart Kennedy, Lcsw, Llc 5669 N Bethmaur Ln Glendale WI 53209-4202 Ph: (414) 614-6299 | Heather Hart Kennedy, Lcsw, Llc 1110 N Old World 3rd St Ste 401 Milwaukee WI 53203-1117 Ph: (414) 224-0800 |
| NPI Number | 1053934034 |
|---|---|
| Provider Enumeration Date | 05/25/2020 |
| Last Update Date | 05/25/2020 |
| Certification Date | 05/25/2020 |
| Medicare PECOS PAC ID | 3870907355 |
|---|---|
| Medicare Enrollment ID | O20210125000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053934034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Heather J Hart Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942379888 PECOS PAC ID: 0749469732 Enrollment ID: I20110124000116 |
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