Provider Demographics
NPI:1225257637
Name:MCLEAN, BONNIE B (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 NW FLANDERS ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2060
Mailing Address - Country:US
Mailing Address - Phone:503-221-7220
Mailing Address - Fax:
Practice Address - Street 1:1815 NW FLANDERS ST
Practice Address - Street 2:STE. 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2060
Practice Address - Country:US
Practice Address - Phone:503-221-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL13791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical