Provider Demographics
NPI:1972874543
Name:MCKEAN, SUSAN L
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:MCKEAN
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 1:17139 WINTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-7573
Mailing Address - Country:US
Mailing Address - Phone:985-748-2220
Mailing Address - Fax:985-748-2236
Practice Address - Street 1:11236 HWY 16 W.
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-748-2220
Practice Address - Fax:985-748-2236
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator