Healthcare Provider Details

I. General information

NPI: 1255433892
Provider Name (Legal Business Name): CATHERINE JOY CLODFELTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BETHESDA PL SUITE 102
WINSTON SALEM NC
27103-3331
US

IV. Provider business mailing address

PO BOX 24937
WINSTON SALEM NC
27114-4937
US

V. Phone/Fax

Practice location:
  • Phone: 336-794-0220
  • Fax: 336-794-1006
Mailing address:
  • Phone: 336-794-0220
  • Fax: 336-794-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1575
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1575
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: