Provider Demographics
NPI:1710262423
Name:MC KENNA, LINDA S NIELSON
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S NIELSON
Last Name:MC KENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O BOX 251
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84629-0251
Mailing Address - Country:US
Mailing Address - Phone:435-427-3499
Mailing Address - Fax:
Practice Address - Street 1:152 N 400 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-5549
Practice Address - Country:US
Practice Address - Phone:435-283-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health