Healthcare Provider Details

I. General information

NPI: 1245426196
Provider Name (Legal Business Name): MEREDITH COLLEEN MCCLANEN N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 SE KING RD
MILWAUKIE OR
97222-2538
US

IV. Provider business mailing address

6501 SE KING RD
MILWAUKIE OR
97222-2538
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-4895
  • Fax: 503-788-8020
Mailing address:
  • Phone: 503-256-4895
  • Fax: 503-788-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1508
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: