Provider Demographics
NPI:1437369774
Name:MCCLUNG, GARY E
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1973
Mailing Address - Country:US
Mailing Address - Phone:816-313-2800
Mailing Address - Fax:816-792-9819
Practice Address - Street 1:5701 STATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1236
Practice Address - Country:US
Practice Address - Phone:913-596-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000128237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist