MEDICARE: BRENDA MCCLELLAN

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	235Z00000X	Speech-Language Pathologist	1432	TN

General Provider Information

NPI Number	:	1285026690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MCCLELLAN

Provider Business Mailing Address
First Line	:	1710 BELCOURT AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3717
Country	:	US
Telephone Number	:	615-383-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 BELCOURT AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3717
Country	:	US
Telephone Number	:	615-383-3570
Fax Number	:

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

Provider Enumeration Date	:	02/22/2015
Last Update Date	:	02/22/2015

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Directions to “ BRENDA MCCLELLAN ” Practice Location

Language	Start Address	Practice Location

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