Provider Demographics
NPI:1982785275
Name:MCCLELLAND, ANNA LAZETTA (SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LAZETTA
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 ROYAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3191
Mailing Address - Country:US
Mailing Address - Phone:440-230-2105
Mailing Address - Fax:
Practice Address - Street 1:2801 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2827
Practice Address - Country:US
Practice Address - Phone:440-526-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist