Provider Demographics
NPI:1417914318
Name:CLAUSEN, HOLLY H (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:H
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E MINNESOTA ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-4691
Mailing Address - Country:US
Mailing Address - Phone:320-363-8055
Mailing Address - Fax:320-363-8056
Practice Address - Street 1:15 E MINNESOTA ST STE 105
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-4691
Practice Address - Country:US
Practice Address - Phone:320-363-8055
Practice Address - Fax:320-363-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP35292084N0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169452OtherUCARE
MN2028501OtherBLUE CROSS
MN268J1CLOtherBLUES
MN108014800Medicaid
MN1015083OtherPREFERRED ONE
MN6149957OtherMEDICA