Basic Information
| Provider Information | |||||||||
| NPI: | 1699101337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLENNEN | ||||||||
| FirstName: | SANDRA | ||||||||
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| Credential: | L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 N SHELDON RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481701046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344536857 | ||||||||
| FaxNumber: | 7344531454 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 W OUTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482353458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133404442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TM1800X | 6301001694 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.