MEDICARE: DR. LINDA ANN MCCLELLAN DO PHD

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	2084P0800X	Psychiatry Physician	M7487	TX
2	2084P0800X	Psychiatry Physician	531087	KS
3	2084P0800X	Psychiatry Physician	00116224	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851389118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA ANN MCCLELLAN DO PHD

Provider Business Mailing Address
First Line	:	8495 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503
Country	:	US
Telephone Number	:	541-826-2111
Fax Number	:	713-627-7302

Provider Business Practice Location Address
First Line	:	8495 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-3011
Country	:	US
Telephone Number	:	541-826-2111
Fax Number	:

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/27/2023

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