Jennifer D Kennedy, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY60869052 Issued in WA

Practice address

5120 Nuthatch CT NE
Lacey, WA 98516-4528

Phone

(360) 890-0694

NPI assigned

Apr 20, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wagaman Enterprises IncGroup PAC ID 0345388641, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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

• Wagaman Enterprises Inc

  • Psychologist
  • Olympia, WA
  • NPI 1740461854
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1555718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555718400000",
    "number": "1548823917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 NUTHATCH CT NE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164528",
            "telephone_number": "360-890-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5120 NUTHATCH CT NE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164528",
            "telephone_number": "360-890-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JENNIFER",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-20",
        "last_updated": "2019-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60869052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wanju S Kellams, LMT
• Robert Charles Keller, LMFT & LMHC
• Erin Kelley
• Sara Kemp, SLP
• Megan Kendig
• Kenneth W Trapp DC Inc
• Bontu Gudeta Kentiba, ARNP
• Kevala Counseling, LLC
• Key Counseling PLLC
• Prachanda Khadka, NP

• Clinical Psychologist in Lacey, WA
• Providers in Lacey, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.