Provider Demographics
NPI:1760971881
Name:MCCLAIN, HALEY MARIE (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 16TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1287
Mailing Address - Country:US
Mailing Address - Phone:630-740-1361
Mailing Address - Fax:
Practice Address - Street 1:1444 16TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1287
Practice Address - Country:US
Practice Address - Phone:630-740-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2246-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer