Provider Demographics
NPI:1063565091
Name:MCKENNA, JOYCE MARLENE (MSW)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:MARLENE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 NORTHWIND DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5034
Mailing Address - Country:US
Mailing Address - Phone:517-324-5426
Mailing Address - Fax:517-324-5426
Practice Address - Street 1:5030 NORTHWIND DR
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5034
Practice Address - Country:US
Practice Address - Phone:517-324-5426
Practice Address - Fax:517-324-5426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010644051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892738OtherBLUE CROSS
MI0892738OtherBLUE CROSS