Provider Demographics
NPI:1275959850
Name:MCKENNA, MEGAN (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CHATHAM CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-8217
Mailing Address - Country:US
Mailing Address - Phone:815-353-8057
Mailing Address - Fax:
Practice Address - Street 1:155 CHATHAM CT
Practice Address - Street 2:UNIT A
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-8217
Practice Address - Country:US
Practice Address - Phone:815-353-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist