Healthcare Provider Details

I. General information

NPI: 1649234535
Provider Name (Legal Business Name): JANICE MCCLEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 UNA AVE
CATHLAMET WA
98612-9583
US

IV. Provider business mailing address

335 UNA AVE
CATHLAMET WA
98612-9583
US

V. Phone/Fax

Practice location:
  • Phone: 360-795-3201
  • Fax: 360-795-3209
Mailing address:
  • Phone: 360-795-3201
  • Fax: 360-795-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: