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General NPI Number Information
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NPI Number | 1518871185
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Entity Type | Individual
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Provider Name | MARK MCLAY
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Gender | Male
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 1711 BRYDEN LN
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City | SANTA ROSA
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State | CA
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Zip | 95404-3646
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Country | US
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Telephone | 707-890-3950
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 LEONARD AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-4520
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Country | US
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Telephone | 707-758-6618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP20528
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License Number State | CA
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