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General NPI Number Information
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NPI Number | 1457592040
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Entity Type | Individual
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Provider Name | WILLIAM G CLAFTON LP
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Gender | Male
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 12/19/2015
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Provider Practice Location Address
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Address Line | 1755 OLD WEST MAIN ST SUITE 204
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City | RED WING
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State | MN
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Zip | 55066-2088
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Country | US
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Telephone | 651-385-9131
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Fax | 651-385-9141
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Provider Business Mailing Address
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Address Line | 1755 OLD WEST MAIN ST SUITE 204
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City | RED WING
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State | MN
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Zip | 55066-2088
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Country | US
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Telephone | 651-385-9131
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Fax | 651-385-9141
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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 | LP4994
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License Number State | MN
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