Provider Demographics
NPI:1013687573
Name:MCCLOUD, DEANNA RAE (MS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RAE
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:RAE
Other - Last Name:WASSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1405 CAMPUS CREEK RD RM 139
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66506-7501
Mailing Address - Country:US
Mailing Address - Phone:785-532-6879
Mailing Address - Fax:785-532-6523
Practice Address - Street 1:1405 CAMPUS CREEK RD RM 139
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66506-7501
Practice Address - Country:US
Practice Address - Phone:785-532-6879
Practice Address - Fax:785-532-6523
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist