Provider Demographics
NPI:1730475773
Name:MCKENNA, CHAVONNE POTTS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHAVONNE
Middle Name:POTTS
Last Name:MCKENNA
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 1:3027 LASH RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9518
Mailing Address - Country:US
Mailing Address - Phone:570-721-0235
Mailing Address - Fax:
Practice Address - Street 1:1710 NYS RTE 13
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-9617
Practice Address - Country:US
Practice Address - Phone:570-721-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106614235Z00000X
NY021514-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist