Healthcare Provider Details

I. General information

NPI: 1417914318
Provider Name (Legal Business Name): HOLLY H CLAUSEN PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MINNESOTA ST STE 105
SAINT JOSEPH MN
56374-4691
US

IV. Provider business mailing address

15 E MINNESOTA ST STE 105
SAINT JOSEPH MN
56374-4691
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-8055
  • Fax: 320-363-8056
Mailing address:
  • Phone: 320-363-8055
  • Fax: 320-363-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLP3529
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP3529
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: