Provider Demographics
NPI:1750050712
Name:CLOGAN, KAELIN (CMHC)
Entity Type:Individual
Prefix:
First Name:KAELIN
Middle Name:
Last Name:CLOGAN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9270
Mailing Address - Country:US
Mailing Address - Phone:724-822-3110
Mailing Address - Fax:
Practice Address - Street 1:11883 PERRY HWY STE D
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7353
Practice Address - Country:US
Practice Address - Phone:724-987-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty