MEDICARE: CLAYTON EDWARD SOWARD CADC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528338555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON EDWARD SOWARD CADC II

Provider Business Mailing Address
First Line	:	2942 WARRINGTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-4051
Country	:	US
Telephone Number	:	408-251-2914
Fax Number	:

Provider Business Practice Location Address
First Line	:	2942 WARRINGTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-4051
Country	:	US
Telephone Number	:	408-251-2914
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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