Provider Demographics
NPI:1134746803
Name:MCKENNA, TAYLOR (MS)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MEGAN CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5022
Mailing Address - Country:US
Mailing Address - Phone:773-706-2225
Mailing Address - Fax:
Practice Address - Street 1:4605 W CRYSTAL LAKE RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5484
Practice Address - Country:US
Practice Address - Phone:027-247-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist