Healthcare Provider Details

I. General information

NPI: 1649207945
Provider Name (Legal Business Name): JENNIFER LYNN MCKAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E COUNTRYSIDE PKWY
YORKVILLE IL
60560-1813
US

IV. Provider business mailing address

1120 E MAIN ST STE. 201
ST CHARLES IL
60174-2287
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-1600
  • Fax: 630-553-7993
Mailing address:
  • Phone: 630-377-6613
  • Fax: 630-377-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008002
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: