Provider Demographics
NPI:1356169957
Name:WELLNER, MCKENNA LYN
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:LYN
Last Name:WELLNER
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 1:112 W 13TH ST APT 26
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1140
Mailing Address - Country:US
Mailing Address - Phone:402-910-7610
Mailing Address - Fax:
Practice Address - Street 1:112 W 13TH ST APT 26
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1140
Practice Address - Country:US
Practice Address - Phone:402-910-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor