Active NPI
Brenda Annette McLellan
- Massage Therapist
- Clarkston, WA
National Provider Identifier
1184416109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MASG-565
- Practice address
- 1370 Bridge St
Clarkston, WA 99403-2332 - Phone
- (509) 780-8840
- NPI assigned
- May 19, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MASG-565 | ID | Primary |
Addresses
Primary practice location
1370 Bridge St
Clarkston, WA 99403-2332
Mailing address
3031 Mayfair Dr
Lewiston, ID 83501-4269
Phone (509) 552-7157
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MASG-565 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747612800000",
"number": "1184416109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3031 MAYFAIR DR",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835014269",
"telephone_number": "509-552-7157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1370 BRIDGE ST",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032332",
"telephone_number": "509-780-8840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCLELLAN",
"first_name": "BRENDA",
"middle_name": "ANNETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-19",
"last_updated": "2025-05-19",
"certification_date": "2025-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MASG-565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.