Individual
MS. MARSHA DIANE MCCLEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUDIOLOGIST
Contact information
Practice address
12001 SOUTH FWY #201, BURLESON, TX 76028
(817) 293-9009
(817) 293-9013
Mailing address
1821 MARTEL AVE, FORT WORTH, TX 76103-1411
(817) 293-9009
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
50429
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00406U
GROUP #CONNECTED WITH PRECEEDING PTAN
TX
01
—
50429
STATE AUDIOLOGY LICENSE
TX
01
—
8L10430
INDIVIDUAL MEDICARE PTAN WITHIN GROUP
TX
Enumeration date
04/26/2007
Last updated
01/29/2010
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