Provider Demographics
NPI:1427511542
Name:MCLENNAN, HEATHER ANN
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:MCLENNAN
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 1:13495 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:OH
Mailing Address - Zip Code:43569-9791
Mailing Address - Country:US
Mailing Address - Phone:419-819-0621
Mailing Address - Fax:
Practice Address - Street 1:13495 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:OH
Practice Address - Zip Code:43569-9791
Practice Address - Country:US
Practice Address - Phone:419-819-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0338079374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338079Medicaid