Provider Demographics
NPI:1912266891
Name:MCCLANAHAN, CAROLYN A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 SOUTH BALTIMORE STREET
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4640
Mailing Address - Country:US
Mailing Address - Phone:660-785-7834
Mailing Address - Fax:660-785-1825
Practice Address - Street 1:2814 SOUTH BALTIMORE STREET
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4640
Practice Address - Country:US
Practice Address - Phone:660-785-7834
Practice Address - Fax:660-785-1825
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist