Individual
MARY CATHERINE MCKENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.
Contact information
Practice address
1316 KNOLLWOOD LN, MENDOTA HEIGHTS, MN 55118-1739
(651) 552-6762
Mailing address
1316 KNOLLWOOD LN, MENDOTA HEIGHTS, MN 55118-1739
(651) 552-6762
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0831
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
336K4MC
BLUE CROSS BLUE SHIELD
MN
01
—
336K5MC
BCBS INDIVDUAL #
MN
Enumeration date
12/16/2005
Last updated
07/08/2007
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