Provider Demographics
NPI:1730702044
Name:MCKENNA, MEGHAN JULIANA (MA, MS)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JULIANA
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 WYNDHAM HILL CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5189
Mailing Address - Country:US
Mailing Address - Phone:916-397-1436
Mailing Address - Fax:
Practice Address - Street 1:900 BLAKE WILBUR DR RM W3036
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2201
Practice Address - Country:US
Practice Address - Phone:916-397-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001233170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS