Provider Demographics
NPI:1770835027
Name:MCKEAN, HEIDI J (ATC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:ATC
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Other - Last Name:
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Mailing Address - Street 1:600 LINCOLN AVE
Mailing Address - Street 2:EASTERN ILLINOIS UNIVERSITY ATHLETIC TRAINING
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3011
Mailing Address - Country:US
Mailing Address - Phone:217-581-3811
Mailing Address - Fax:217-581-8300
Practice Address - Street 1:600 LINCOLN AVE
Practice Address - Street 2:EASTERN ILLINOIS UNIVERSITY ATHLETIC TRAINING
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3011
Practice Address - Country:US
Practice Address - Phone:217-581-3811
Practice Address - Fax:217-581-8300
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL096.0034352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer