Provider Demographics
NPI:1003358508
Name:MCCLELLAN, CHARNELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHARNELLE
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2338
Mailing Address - Country:US
Mailing Address - Phone:336-383-8887
Mailing Address - Fax:
Practice Address - Street 1:1320 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2338
Practice Address - Country:US
Practice Address - Phone:336-383-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12296235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist