Provider Demographics
NPI:1881704708
Name:MCCLELLAN, MICHELLE LYNNE (PSY D)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNNE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:FLIGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WEST TERRA COTTA AVE #9
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:847-254-0654
Mailing Address - Fax:815-479-9146
Practice Address - Street 1:330 WEST TERRA COTTA AVE #9
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:847-254-0654
Practice Address - Fax:815-479-9146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2778-57103TC0700X
IL071-006469103TC0700X
IL0.71006469103TC0700X
AZ4245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical