Provider Demographics
NPI:1942617188
Name:MCCLENAHAN, KIERAN
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:MCCLENAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIERAN
Other - Middle Name:
Other - Last Name:MCKINNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:202 E SPOKANE FALLS BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1612
Practice Address - Country:US
Practice Address - Phone:509-624-4035
Practice Address - Fax:509-624-3055
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60480124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01476740OtherRR MEDICARE PTAN
WA2039509Medicaid
WAP01476740OtherRR MEDICARE PTAN