Provider Demographics
NPI:1255521779
Name:MCCLELLAN, GARY E (MA IN AUDIOLOGY)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:E
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:MA IN AUDIOLOGY
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Mailing Address - Street 1:1508 DIVISION ST
Mailing Address - Street 2:#115
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2032
Mailing Address - Country:US
Mailing Address - Phone:503-656-0601
Mailing Address - Fax:503-656-1389
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:#115 GARY E MCCLELLAN MA
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2032
Practice Address - Country:US
Practice Address - Phone:503-656-0601
Practice Address - Fax:503-656-1389
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR20346231H00000X
ORHASP855737332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment