Provider Demographics
NPI:1982680815
Name:MCDADE, CLYDE O (LMP)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:O
Last Name:MCDADE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BLACK HILLS LN SW STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8146
Mailing Address - Country:US
Mailing Address - Phone:360-763-9439
Mailing Address - Fax:360-252-6139
Practice Address - Street 1:402 BLACK HILLS LN SW STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8146
Practice Address - Country:US
Practice Address - Phone:360-763-9439
Practice Address - Fax:360-252-6139
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist