Provider Demographics
NPI:1396940631
Name:MCLEAN, ROSE (PT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:ANDERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 N LINCOLN PARK W
Mailing Address - Street 2:#1112
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4652
Mailing Address - Country:US
Mailing Address - Phone:773-771-5348
Mailing Address - Fax:
Practice Address - Street 1:3105 N WILKE RD
Practice Address - Street 2:SUITE H
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1495
Practice Address - Country:US
Practice Address - Phone:847-255-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist