Provider Demographics
NPI:1083700108
Name:MCCLARY, FAITH ANNETTE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ANNETTE
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 MINT LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4611
Mailing Address - Country:US
Mailing Address - Phone:615-941-5169
Mailing Address - Fax:
Practice Address - Street 1:52 W 8TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-4656
Practice Address - Country:US
Practice Address - Phone:731-847-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist