Provider Demographics
NPI:1336528769
Name:MCCLERNAN, LINDSAY A (CAPSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:A
Last Name:MCCLERNAN
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1692
Mailing Address - Country:US
Mailing Address - Phone:608-274-4471
Mailing Address - Fax:
Practice Address - Street 1:2658 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1692
Practice Address - Country:US
Practice Address - Phone:608-274-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129638-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical