Kennedy Patton, Theresa Ann
Kennedy Patton, Theresa Ann is an sole proprietor health care provider with primary practice located at 617 Stephanie Ct , Washington IL 61571-9279. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Counselor, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Kennedy Patton, Theresa Ann can be contacted via phone (317) 799-4343.Contact Information
Primary practice address
617 Stephanie Ct
Washington IL 61571-9279
Phone: (317) 799-4343
Fax: (317) 643-8989
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 15216 | Arizona |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 87001357A | Indiana |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 16405 | Texas |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Counselor | 225C00000X | 204377 | Indiana |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 180015238 | Illinois |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 1804 | North Carolina |
Profile Details
| NPI number | 1114210721 |
|---|---|
| LBN Legal business name | Kennedy Patton, Theresa Ann |
| Credentials | LCPC CRC LCAC LISAC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 16th, 2011 |
| Last updated | Jul 16th, 2024 - about 5 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114210721 | NPPES |
| Illinois | MEDICAID | 1114210721 | |
| Illinois | Other | 1114210721 |
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