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Kennady Lake, AAC,CPC
Peer Specialist in Longview, Washington
NPI 1619747649

Kennady Lake is a Peer Specialist based in Longview, WA. Kennady Lake practices in Longview, WA and has the professional credentials of AAC,CPC. The NPI Number for Kennady Lake is 1619747649 and holds a License No. CG61505391 (Washington).

The current practice location address for Kennady Lake is 1400 Commerce Ave, Longview, WA and can be reached out via phone at 360-998-2047 and via fax at 360-200-6736.

Location: 1400 Commerce Ave, Longview, WA, 98632-8455
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619747649
Provider Name
Kennady Lake
Credential
AAC,CPC
Provider Entity Type
Individual
Gender
Female
Address
1400 Commerce Ave, Longview, WA, 98632-8455
Phone Number
360-998-2047
Fax Number
360-200-6736
Provider Enumeration Date
01/02/2024
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1400 Commerce Ave
City
Longview
State
Washington
Zip
98632-3756
Phone Number
360-998-2047
Fax Number
360-200-6736
person
Provider Business Mailing Address Details
Address
1400 Commerce Ave
City
Longview
State
Washington
Zip
98632-3756
Phone Number
360-998-2047
Fax Number
360-200-6736
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
CG61505391 (Washington)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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