Active NPI
Jaclyn Mae Kennedy, LMFT
- Marriage & Family Therapist
- Brooklyn Park, MN
National Provider Identifier
1922876317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 4447
- Practice address
- 9100 93Rd Ave N
Brooklyn Park, MN 55445-1407 - Phone
- (763) 710-6133
- NPI assigned
- Dec 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 4447 | MN | Primary |
Addresses
Primary practice location
9100 93Rd Ave N
Brooklyn Park, MN 55445-1407
Mailing address
8390 Mississippi Blvd NW
Coon Rapids, MN 55433-5938
Phone (763) 710-6133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4447 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702512000000",
"number": "1922876317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8390 MISSISSIPPI BLVD NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335938",
"telephone_number": "763-710-6133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9100 93RD AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554451407",
"telephone_number": "763-710-6133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "JACLYN",
"middle_name": "MAE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-14",
"last_updated": "2023-12-14",
"certification_date": "2023-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "4447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.