Individual
MCKENNA M POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
704 W ABE ST, PLANO, IL 60545-1167
(630) 552-3178
Mailing address
PO BOX 3, SOMONAUK, IL 60552-0003
(815) 545-5591
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.005700
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
09/01/2021
Last updated
10/24/2023
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