Provider Demographics
NPI:1093272221
Name:MCLEAN, ELAINE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MCLEAN
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 1:1323 W RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6216
Mailing Address - Country:US
Mailing Address - Phone:908-590-5283
Mailing Address - Fax:
Practice Address - Street 1:1323 W RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6216
Practice Address - Country:US
Practice Address - Phone:908-590-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 102L00000X, 177F00000X, 251J00000X, 374T00000X, 374U00000X, 376K00000X, 251E00000X
OH168420164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide