Provider Demographics
NPI:1821242280
Name:MCLENNAN, MARY ROBIN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ROBIN
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAKHILL DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2710
Mailing Address - Country:US
Mailing Address - Phone:513-664-5189
Mailing Address - Fax:
Practice Address - Street 1:507 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2211
Practice Address - Country:US
Practice Address - Phone:513-330-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH66.000147171100000X
IN84000089A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist