MEDICARE: KELLEN MCLAUGHLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	2360-28-4324	IN

General Provider Information

NPI Number	:	1376004812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEN MCLAUGHLIN

Provider Business Mailing Address
First Line	:	715 HOLLYWOOD CT
Second Line	:
City	:	WHITING
State	:	IN
Zip	:	46394-1829
Country	:	US
Telephone Number	:	219-314-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 HOLLYWOOD CT
Second Line	:
City	:	WHITING
State	:	IN
Zip	:	46394-1829
Country	:	US
Telephone Number	:	219-314-8409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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Directions to “ KELLEN MCLAUGHLIN ” Practice Location

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