Provider Demographics
NPI:1548244932
Name:MCCLELLAN, JON MONTGOMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MONTGOMERY
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13925 PAR PL NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3054
Mailing Address - Country:US
Mailing Address - Phone:206-367-7290
Mailing Address - Fax:
Practice Address - Street 1:8805 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4770
Practice Address - Country:US
Practice Address - Phone:253-756-2319
Practice Address - Fax:253-756-3911
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000232822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry