Healthcare Provider Details

I. General information

NPI: 1588325450
Provider Name (Legal Business Name): KERRI D. MCKENNA MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 VICTORY PKWY
CINCINNATI OH
45206-1711
US

IV. Provider business mailing address

8903 PEMBROOKE ST
MAINEVILLE OH
45039-9742
US

V. Phone/Fax

Practice location:
  • Phone: 513-338-8597
  • Fax:
Mailing address:
  • Phone: 513-404-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608463
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: