Provider Demographics
NPI:1376004812
Name:MCLAUGHLIN, KELLEN
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:MCLAUGHLIN
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 1:715 HOLLYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1829
Mailing Address - Country:US
Mailing Address - Phone:219-314-8409
Mailing Address - Fax:
Practice Address - Street 1:715 HOLLYWOOD CT
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1829
Practice Address - Country:US
Practice Address - Phone:219-314-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2360-28-4324347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle