Jessica L Kennedy Herrmann, LCSW, LCAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34006146A Issued in IN

Practice address

9111 Broadway
Broadfield Center Suite N
Merrillville, IN 46410-8122

Phone

(219) 791-1006

Fax

(219) 791-1007

NPI assigned

Sep 21, 2007

Last updated

Jan 9, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1295921351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9111 BROADWAY",
            "address_2": "BROADFIELD CENTER SUITE N",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464108122",
            "telephone_number": "219-791-1006",
            "fax_number": "219-791-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9111 BROADWAY",
            "address_2": "BROADFIELD CENTER SUITE N",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464108122",
            "telephone_number": "219-791-1006",
            "fax_number": "219-791-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY HERRMANN",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LCAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-21",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "877001276A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006146A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID",
            "identifier": "200264420",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith M Ramsey Medical Corp
• Keith M Ramsey Medical Corp
• Michael Ryan Kelley, O.D.
• Elizabeth Keneson
• Kennedy Herrmann & Associates LLC
• George E Kennedy, P.T.
• Tenisha Kennedy
• Tamara Kenning
• Cailyn Kern
• Patricia Kerr, BA

• Clinical Social Worker in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.