Provider Demographics
NPI:1265655336
Name:CLEVE, CLARA A (MSSW)
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:A
Last Name:CLEVE
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-0445
Mailing Address - Country:US
Mailing Address - Phone:715-345-1965
Mailing Address - Fax:715-254-0372
Practice Address - Street 1:1052 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2848
Practice Address - Country:US
Practice Address - Phone:715-345-1965
Practice Address - Fax:715-254-0372
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1473-123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39577700Medicaid
WI39577700Medicaid