Provider Demographics
NPI:1821141896
Name:MCLELLAN, DAN PATRICK (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:PATRICK
Last Name:MCLELLAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 N FORK CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3548
Mailing Address - Country:US
Mailing Address - Phone:303-817-5055
Mailing Address - Fax:303-530-5285
Practice Address - Street 1:5520 N FORK CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3548
Practice Address - Country:US
Practice Address - Phone:303-817-5055
Practice Address - Fax:303-530-5285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05322839Medicaid