Healthcare Provider Details

I. General information

NPI: 1912600495
Provider Name (Legal Business Name): ROSALIND MCCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N IRONWOOD RD STE 210
GLENDALE WI
53217-4909
US

IV. Provider business mailing address

5413 W DONGES LN
BROWN DEER WI
53223-1359
US

V. Phone/Fax

Practice location:
  • Phone: 414-249-8756
  • Fax:
Mailing address:
  • Phone: 414-249-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19634-130
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: