Healthcare Provider Details

I. General information

NPI: 1720895998
Provider Name (Legal Business Name): MCKENNA R PATTERSON CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 BRIDGETOWN RD STE 4
CINCINNATI OH
45248-4346
US

IV. Provider business mailing address

1787 GLOUCESTER DR
FAIRFIELD OH
45014-3709
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 513-628-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406314-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2406314-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: