Healthcare Provider Details

I. General information

NPI: 1407720709
Provider Name (Legal Business Name): MCKENNA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 400
CHICAGO IL
60601-7511
US

IV. Provider business mailing address

6410 N HOYNE AVE APT 3E
CHICAGO IL
60645-5719
US

V. Phone/Fax

Practice location:
  • Phone: 312-870-0010
  • Fax:
Mailing address:
  • Phone: 810-588-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: