Healthcare Provider Details

I. General information

NPI: 1205789039
Provider Name (Legal Business Name): JACQUELINE MCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RAINBOW LN
INDIANAPOLIS IN
46260-4613
US

IV. Provider business mailing address

705 RAINBOW LN
INDIANAPOLIS IN
46260-4613
US

V. Phone/Fax

Practice location:
  • Phone: 317-833-6985
  • Fax:
Mailing address:
  • Phone: 317-833-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number28141117A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: