Provider Demographics
NPI:1629214168
Name:MCCLENNEN, JAY DONALD (AOCAD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DONALD
Last Name:MCCLENNEN
Suffix:
Gender:M
Credentials:AOCAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1911 HILLANDALE RD
Mailing Address - Street 2:UNIT 1110
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2666
Mailing Address - Country:US
Mailing Address - Phone:919-383-1205
Mailing Address - Fax:
Practice Address - Street 1:1911 HILLANDALE RD
Practice Address - Street 2:UNIT 1110
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2666
Practice Address - Country:US
Practice Address - Phone:919-383-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist