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General NPI Number Information
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NPI Number | 1457681090
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Entity Type | Organization
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Legal Business Name | MCKENNA QUALITY THERAPEUTIC SERVICES, P.C.
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 3517 W PALMER ST # 2
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City | CHICAGO
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State | IL
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Zip | 60647-3519
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Country | US
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Telephone | 312-714-5154
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Fax | 312-854-2850
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Provider Business Mailing Address
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Address Line | 3517 W PALMER ST # 2
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City | CHICAGO
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State | IL
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Zip | 60647-3519
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Country | US
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Telephone | 312-714-5154
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Fax | 312-854-2850
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Authorized Official
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Title or Position | THERAPIST/CLINICAL CONSULTANT
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Name | ALISON BETH MCKENNA
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Credential | LCSW
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Telephone | 312-714-5154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.012601
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License Number State | IL
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