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General NPI Number Information
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NPI Number | 1255451688
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Entity Type | Individual
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Provider Name | CLIFFORD K STEPHENS PH.D
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1300 SOUTH DRIVE
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City | WINNEBAGO
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State | WI
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Zip | 54985-0009
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Country | US
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Telephone | 920-235-4910
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Fax | 920-236-2931
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Provider Business Mailing Address
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Address Line | 1071 GOLDENROD DR
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City | APPLETON
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State | WI
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Zip | 54914-8892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2057-057
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License Number State | WI
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