Provider Demographics
NPI:1184852402
Name:MCCLINTOCK, CLAIRE DUGAN
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:DUGAN
Last Name:MCCLINTOCK
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 1:510 WASHINGTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2053
Mailing Address - Country:US
Mailing Address - Phone:219-221-6465
Mailing Address - Fax:
Practice Address - Street 1:12845 PARRISH AVE
Practice Address - Street 2:JULIE BERG SPEECH PATHOLOGY, P.C.
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303
Practice Address - Country:US
Practice Address - Phone:219-374-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001968A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist