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NPI Code Detail

MEDICARE: CAROLINE J MCKENNA LCSW

MEDICARE: CAROLINE J MCKENNA LCSW
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
11041C0700XClinical Social WorkerSWI.LW.61219416WA
21041C0700XClinical Social WorkerL5410OR

General Provider Information

NPI Number : 1609037860
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE J MCKENNA LCSW
Provider Business Mailing Address
First Line : 2517 NE 199TH ST
Second Line :
City : RIDGEFIELD
State : WA
Zip : 98642-7960
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7600 NE 41ST ST STE 200
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-6772
Country : US
Telephone Number : 425-477-4217
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2008
Last Update Date : 06/12/2026

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Directions to “ CAROLINE J MCKENNA LCSW” Practice Location

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