Individual
MCKENNA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(312) 942-5000
Mailing address
3535 OLENTANGY RIVER RD, COLUMBUS, OH 43214-3908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.011527
IL
Other
Enumeration date
06/24/2024
Last updated
09/10/2025
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