Provider Demographics
NPI:1417327180
Name:STRATFORD, CLARA (BA)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:STRATFORD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W TYTUS DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4820
Mailing Address - Country:US
Mailing Address - Phone:347-463-4889
Mailing Address - Fax:
Practice Address - Street 1:46 W TYTUS DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4820
Practice Address - Country:US
Practice Address - Phone:347-463-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker