Provider Demographics
NPI:1629930540
Name:GARNER, KEENA M (CD, PCD, CLS, MHFA)
Entity type:Individual
Prefix:
First Name:KEENA
Middle Name:M
Last Name:GARNER
Suffix:
Gender:F
Credentials:CD, PCD, CLS, MHFA
Other - Prefix:
Other - First Name:KEENA
Other - Middle Name:
Other - Last Name:MICHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD, PCD,CLS
Mailing Address - Street 1:1935 E 71ST ST APT 216
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2099
Mailing Address - Country:US
Mailing Address - Phone:773-354-3776
Mailing Address - Fax:
Practice Address - Street 1:1935 E 71ST ST APT 216
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2099
Practice Address - Country:US
Practice Address - Phone:773-354-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN