Provider Demographics
NPI:1184295792
Name:MCCLELLAN, SUZANNE THERESE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:THERESE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17723 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3518
Mailing Address - Country:US
Mailing Address - Phone:586-914-2241
Mailing Address - Fax:
Practice Address - Street 1:50920 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-1367
Practice Address - Country:US
Practice Address - Phone:586-307-4757
Practice Address - Fax:855-393-6740
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist