Provider Demographics
NPI:1265042790
Name:MCCLURG, MAGAN (MA, CF- SLP)
Entity Type:Individual
Prefix:
First Name:MAGAN
Middle Name:
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:MA, CF- SLP
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:MCCLURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 POSEY LN APT 212
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2288
Mailing Address - Country:US
Mailing Address - Phone:937-522-5668
Mailing Address - Fax:
Practice Address - Street 1:750 E 4TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2308
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OHCOND.20201465-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist