Provider Demographics
NPI:1588340186
Name:MCLEAN, MITCHELL TYLER
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:TYLER
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 CRIDER RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2380
Mailing Address - Country:US
Mailing Address - Phone:724-814-4968
Mailing Address - Fax:
Practice Address - Street 1:4700 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1166
Practice Address - Country:US
Practice Address - Phone:330-896-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist