Provider Demographics
NPI:1427377696
Name:MCKENNA, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:KAPLAN MCKENNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3517 W PALMER ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3519
Mailing Address - Country:US
Mailing Address - Phone:312-714-5154
Mailing Address - Fax:312-854-2850
Practice Address - Street 1:3517 W PALMER ST
Practice Address - Street 2:SUITE #2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3519
Practice Address - Country:US
Practice Address - Phone:312-714-5154
Practice Address - Fax:312-854-2850
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0126011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1457681090OtherNPI TYPE 2