Provider Demographics
NPI:1558196444
Name:MCCLUNG, LILLIAN FAY (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:FAY
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 KAE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6100
Mailing Address - Country:US
Mailing Address - Phone:614-417-5600
Mailing Address - Fax:
Practice Address - Street 1:4750 KAE AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-6100
Practice Address - Country:US
Practice Address - Phone:614-417-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20242801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist