Provider Demographics
NPI:1588783070
Name:MCCLELLAN, JULIE K (BSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MARY LINDA ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1027
Mailing Address - Country:US
Mailing Address - Phone:606-348-6466
Mailing Address - Fax:606-348-6426
Practice Address - Street 1:301 MARY LINDA ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1027
Practice Address - Country:US
Practice Address - Phone:606-348-6466
Practice Address - Fax:606-348-6426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator