Healthcare Provider Details

I. General information

NPI: 1306754825
Provider Name (Legal Business Name): JULIANNA MCKENNA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 W LAKE ST
CHICAGO IL
60644-2343
US

IV. Provider business mailing address

PCC WELLNESS 5461 W LAKE ST
CHICAGO IL
60644-2343
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-3080
  • Fax:
Mailing address:
  • Phone: 773-295-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150130255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: