Healthcare Provider Details

I. General information

NPI: 1265623482
Provider Name (Legal Business Name): KRISTINE MCKENNA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DR CHILDREN'S HOSPITAL GUIDANCE CENTER
COLUMBUS OH
43205
US

IV. Provider business mailing address

899 E BROAD ST 3RD FLOOR CHILDREN'S HOSPITAL GUIDANCE CENTER
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8080
  • Fax: 614-355-8095
Mailing address:
  • Phone: 614-355-8000
  • Fax: 614-355-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: