Provider Demographics
NPI:1568763100
Name:MCCLURE, MARY JOAN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:MCCLURE
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 1:5905 WHISPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4342
Mailing Address - Country:US
Mailing Address - Phone:919-619-5328
Mailing Address - Fax:
Practice Address - Street 1:5905 WHISPERWOOD DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4342
Practice Address - Country:US
Practice Address - Phone:919-619-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist