Provider Demographics
NPI:1790808632
Name:MCCLURE, ELIZABETH LENORE (AA DEGREE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LENORE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:AA DEGREE
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LENORE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA DEGREE
Mailing Address - Street 1:1888 NUT TREE DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1073 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4018
Practice Address - Country:US
Practice Address - Phone:503-585-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator