Provider Demographics
NPI:1215055587
Name:MCCLELLAND, DAWN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ELIZABETH
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:763-541-1973
Mailing Address - Fax:952-938-6969
Practice Address - Street 1:1660 S HWY 100
Practice Address - Street 2:#428
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:763-541-1973
Practice Address - Fax:952-938-6969
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical