Basic Information
| Provider Information | |||||||||
| NPI: | 1306060884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEY | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 641130 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681647130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722907 | ||||||||
| FaxNumber: | 4025723544 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 HARMONY ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515033106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123282609 | ||||||||
| FaxNumber: | 7123289257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6323 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.