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General NPI Number Information
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NPI Number | 1417081217
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Entity Type | Individual
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Provider Name | JEFFREY CLEARWATER M.A. LLP
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 551 LINN ST SUITE 230
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City | ALLEGAN
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State | MI
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Zip | 49010-1595
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Country | US
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Telephone | 269-686-4110
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Fax | 269-686-2135
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Provider Business Mailing Address
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Address Line | 551 LINN ST SUITE 230
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City | ALLEGAN
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State | MI
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Zip | 49010-1595
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Country | US
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Telephone | 269-686-4110
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Fax | 269-686-2135
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | JC011643
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License Number State | MI
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