Provider Demographics
NPI:1265655468
Name:MCCLENAHAN, LINDA (MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCCLENAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1934
Mailing Address - Country:US
Mailing Address - Phone:414-571-9484
Mailing Address - Fax:414-571-9648
Practice Address - Street 1:6929 MARINER DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3938
Practice Address - Country:US
Practice Address - Phone:414-571-9484
Practice Address - Fax:414-571-9648
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3181-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40935800Medicaid