Provider Demographics
NPI:1023041993
Name:MCKANNA, TRUDY (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:
Last Name:MCKANNA
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2508
Mailing Address - Country:US
Mailing Address - Phone:616-391-5442
Mailing Address - Fax:
Practice Address - Street 1:21 MICHIGAN ST NE STE 465
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2530
Practice Address - Country:US
Practice Address - Phone:616-391-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS