Provider Demographics
NPI:1649534041
Name:MACCLELLAN, NICOLE RUTH (MS SPED/ELED)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RUTH
Last Name:MACCLELLAN
Suffix:
Gender:F
Credentials:MS SPED/ELED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2905
Mailing Address - Country:US
Mailing Address - Phone:716-208-4333
Mailing Address - Fax:
Practice Address - Street 1:23 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-2905
Practice Address - Country:US
Practice Address - Phone:716-208-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist