MEDICARE: SAVANNAH RUTH MCLEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1275297079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH RUTH MCLEAN

Provider Business Mailing Address
First Line	:	8606 WEBER CT APT A
Second Line	:
City	:	TWENTYNINE PALMS
State	:	CA
Zip	:	92277-8667
Country	:	US
Telephone Number	:	412-735-8422
Fax Number	:

Provider Business Practice Location Address
First Line	:	73321 FRED WARING DR STE 101
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-2890
Country	:	US
Telephone Number	:	760-565-2701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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