Provider Demographics
NPI:1508909219
Name:MCLEAN, SHANNON ROCHELLE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROCHELLE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 HIGHWAY 99 N
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2301
Mailing Address - Country:US
Mailing Address - Phone:541-461-2845
Mailing Address - Fax:541-688-4163
Practice Address - Street 1:780 HIGHWAY 99 N
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2301
Practice Address - Country:US
Practice Address - Phone:541-461-2845
Practice Address - Fax:541-688-4163
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health