Provider Demographics
NPI:1700849619
Name:MCKENNA, DEBORAH J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1752
Mailing Address - Country:US
Mailing Address - Phone:309-691-2089
Mailing Address - Fax:309-691-2089
Practice Address - Street 1:7150 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1752
Practice Address - Country:US
Practice Address - Phone:309-691-2089
Practice Address - Fax:309-691-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL030383637OtherEMPLOYEE IDENTIFICATION