Provider Demographics
NPI:1356796874
Name:MCLEAN, AMY L (APRN, NP-C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:APRN, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1028
Mailing Address - Country:US
Mailing Address - Phone:618-548-4545
Mailing Address - Fax:618-545-4577
Practice Address - Street 1:1275 HAWTHORN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1028
Practice Address - Country:US
Practice Address - Phone:618-548-4545
Practice Address - Fax:618-545-4577
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014035363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily