MEDICARE: MCKENNA MARIE GARLAND PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	129415	IA

General Provider Information

NPI Number	:	1003744285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENNA MARIE GARLAND PHD

Provider Business Mailing Address
First Line	:	12493 UNIVERSITY AVE STE 100
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8286
Country	:	US
Telephone Number	:	515-358-0060
Fax Number	:

Provider Business Practice Location Address
First Line	:	12493 UNIVERSITY AVE STE 100
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8286
Country	:	US
Telephone Number	:	515-358-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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