Provider Demographics
NPI:1639593460
Name:MCLEAN, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
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 1:3900 COTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SHARONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1616
Mailing Address - Country:US
Mailing Address - Phone:513-864-1000
Mailing Address - Fax:
Practice Address - Street 1:930 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-4423
Practice Address - Country:US
Practice Address - Phone:513-864-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCI1013278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist