Provider Demographics
NPI:1720686397
Name:MCKENNA, DREW ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:ELIZABETH
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:ELIZABETH
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR
Mailing Address - Street 1:5202 TEXANA DR APT 215
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3773
Mailing Address - Country:US
Mailing Address - Phone:219-241-5557
Mailing Address - Fax:
Practice Address - Street 1:8410 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3220
Practice Address - Country:US
Practice Address - Phone:210-870-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81307OtherTEXAS AUDIOLOGY LICENSE