Provider Demographics
NPI:1689020893
Name:MCCLURE, DANA E (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:E
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 FENROSE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1213
Mailing Address - Country:US
Mailing Address - Phone:757-303-8658
Mailing Address - Fax:
Practice Address - Street 1:4034 FENROSE CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1213
Practice Address - Country:US
Practice Address - Phone:321-591-1250
Practice Address - Fax:321-541-9147
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist