Individual
MS. TRISH MCKENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
13035 W BLUEMOUND RD STE 100, BROOKFIELD, WI 53005-8001
(262) 244-0729
Mailing address
13035 W BLUEMOUND RD STE 100, BROOKFIELD, WI 53005-8001
(262) 244-0729
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39020000X
39020000X
WI
05
—
39020000X
—
WI
Enumeration date
11/30/2021
Last updated
11/30/2021
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