Provider Demographics
NPI:1811183452
Name:MCKENNON, DANA (PSYD)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:MCKENNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DOINA
Other - Middle Name:ROXANA
Other - Last Name:PORUMBESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:121 S. WILKE RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-577-0904
Mailing Address - Fax:847-577-1558
Practice Address - Street 1:121 S. WILKE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-577-0904
Practice Address - Fax:847-577-1558
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional