Provider Demographics
NPI:1366461907
Name:MCCLINTOCK, PATRICIA MARIE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 GROVE DRIVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4036
Mailing Address - Country:US
Mailing Address - Phone:773-415-7564
Mailing Address - Fax:
Practice Address - Street 1:385 WINNETKA AVENUE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4237
Practice Address - Country:US
Practice Address - Phone:847-784-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer