MEDICARE: ELIZABETH ROSE MCKENNA

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1366991382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROSE MCKENNA

Provider Business Mailing Address
First Line	:	662 W CHESTER ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1707
Country	:	US
Telephone Number	:	516-232-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	662 W CHESTER ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1707
Country	:	US
Telephone Number	:	516-232-5144
Fax Number	:

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

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/07/2024

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Directions to “ ELIZABETH ROSE MCKENNA ” Practice Location

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