Provider Demographics
NPI:1053934034
Name:HEATHER HART KENNEDY, LCSW, LLC
Entity type:Organization
Organization Name:HEATHER HART KENNEDY, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HART KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:414-614-6299
Mailing Address - Street 1:5669 N BETHMAUR LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4202
Mailing Address - Country:US
Mailing Address - Phone:414-614-6299
Mailing Address - Fax:414-431-4236
Practice Address - Street 1:1110 N OLD WORLD 3RD ST STE 401
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1117
Practice Address - Country:US
Practice Address - Phone:414-224-0800
Practice Address - Fax:414-224-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)