Healthcare Provider Details

I. General information

NPI: 1548432024
Provider Name (Legal Business Name): HEATHER B MCCLELLAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6825
US

IV. Provider business mailing address

12875 CHIPPEWA DR
GRAND LEDGE MI
48837-8997
US

V. Phone/Fax

Practice location:
  • Phone: 517-237-7162
  • Fax:
Mailing address:
  • Phone: 517-882-4000
  • Fax: 517-882-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801070577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: