Stephanie Kennedy, CHN, LMT
Individual provider Active NPI Nutritionist · Detroit, MI
NPI 1568062867 · NPPES record last updated Oct 27, 2020
Key facts
- NPI
- 1568062867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nutritionist 133N00000X
- License
- 89433--CERTIFICATION (MI)
- Practice address
- 207 E Baltimore St
Detroit, MI 48202-3278 - Phone
- (313) 600-7505
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89433--CERTIFICATION | MI | MD | Nutritionist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 89433--CERTIFICATION | MI | Yes |
Addresses
Primary practice location
207 E Baltimore St
Detroit, MI 48202-3278
Mailing address
207 E Baltimore St Apt 6
Detroit, MI 48202-3278
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.