Healthcare Provider Details

I. General information

NPI: 1598751042
Provider Name (Legal Business Name): ELIZABETH WATERS MCLEAN SLP/CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH MEDICAL GROUP UNIT 7095 BOX 185
APO AE
09824
TR

IV. Provider business mailing address

39TH MEDICAL GROUP UNIT 7095 BOX 185
APO AE
09824
TR

V. Phone/Fax

Practice location:
  • Phone: 011903223163380
  • Fax:
Mailing address:
  • Phone: 011903223163380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP004283
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: