Provider Demographics
NPI:1184867087
Name:MCKINLEY, JOANNA MICHELLE (CMT, HHP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MICHELLE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:CMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WOODROW AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1158
Mailing Address - Country:US
Mailing Address - Phone:209-595-5351
Mailing Address - Fax:
Practice Address - Street 1:144 WOODROW AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1158
Practice Address - Country:US
Practice Address - Phone:209-595-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0583389175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath