Provider Demographics
NPI:1346578499
Name:MCCLELLAN, SANDRA BERNICE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BERNICE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SUNSET DR APT 318
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-4516
Mailing Address - Country:US
Mailing Address - Phone:952-294-9978
Mailing Address - Fax:
Practice Address - Street 1:560 MARKET ST STE 11
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4644
Practice Address - Country:US
Practice Address - Phone:952-294-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1479171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist