Healthcare Provider Details

I. General information

NPI: 1750299947
Provider Name (Legal Business Name): KATHLEEN QUENAN MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE QUENAN

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 CHESTNUT RD
EAST LANSING MI
48824-3434
US

IV. Provider business mailing address

1510 S PRINCETON AVE
ARLINGTON HEIGHTS IL
60005-3415
US

V. Phone/Fax

Practice location:
  • Phone: 407-860-5293
  • Fax:
Mailing address:
  • Phone: 224-217-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601003287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: