Dana Marie Kennelly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3547 Issued in ND

Practice address

2400 47TH Ave S
Grand Forks, ND 58201-3405

Phone

(701) 215-5906

NPI assigned

Nov 8, 2006

Last updated

Sep 9, 2024By 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Village Family Service Center

  dba The Village Family Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1568492353

  Social Worker

  NPD (past)
• Village Family Service Center

  dba The Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1457420754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 47TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013405",
            "telephone_number": "701-746-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 47TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013405",
            "telephone_number": "701-215-5906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 S 4th St",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582014715",
            "country_code": "US",
            "telephone_number": "701-795-3000",
            "fax_number": "701-795-3050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "DANA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "3547",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "3547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "027884",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054519",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Mark Kelly
• Sheila B Kemnitz-Hartje, OTR/L
• Walter Loren Kemp, MD, PHD
• Rebecca R Kendall, MS
• Marlena Kennedy, ND
• Kevin Keith Kern, PHARM D
• William H Kerzman
• Vanessa Kes, DNP, APRN, WHNP-BC
• Samantha Ann Ketterling, PHARMD
• Caron Hannah Keys, OTR/L

• Clinical Social Worker in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.