Provider Demographics
NPI:1659812055
Name:POWELL, MCKENNA LEEANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:LEEANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 EVENING STAR DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2709
Mailing Address - Country:US
Mailing Address - Phone:210-833-3135
Mailing Address - Fax:
Practice Address - Street 1:4503 EVENING STAR DR
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2709
Practice Address - Country:US
Practice Address - Phone:210-833-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist