Provider Demographics
NPI:1235106709
Name:MCCLENAHAN, ANN CATHERINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:CATHERINE
Last Name:MCCLENAHAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5732
Mailing Address - Country:US
Mailing Address - Phone:605-339-7190
Mailing Address - Fax:605-221-0310
Practice Address - Street 1:111 W 39TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5732
Practice Address - Country:US
Practice Address - Phone:605-339-7190
Practice Address - Fax:605-221-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD204103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6550120Medicaid
SD22267OtherSIOUX VALLEY HEALTH PLAN
SD0004708OtherBLUE CROSS BLUE SHIELD
4708Medicare ID - Type Unspecified