Provider Demographics
NPI:1093017709
Name:MCCLELLAN, JENNIFER LYNN (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:LUDHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 CASTLETON CT
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9202
Mailing Address - Country:US
Mailing Address - Phone:740-973-7119
Mailing Address - Fax:
Practice Address - Street 1:600 INDUSTRIAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1528
Practice Address - Country:US
Practice Address - Phone:740-973-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 10003371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical