Provider Demographics
NPI:1689420812
Name:HALE, KENNEDY ANNE
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:ANNE
Last Name:HALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1361
Mailing Address - Country:US
Mailing Address - Phone:330-949-6484
Mailing Address - Fax:
Practice Address - Street 1:544 BELDEN PKWY NE
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-7695
Practice Address - Country:US
Practice Address - Phone:330-949-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty