Provider Demographics
NPI:1467217935
Name:CLAWSON, VINCENT DANIEL (LMT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:DANIEL
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SUNSET HWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4304
Mailing Address - Country:US
Mailing Address - Phone:509-393-6599
Mailing Address - Fax:
Practice Address - Street 1:1737 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1189
Practice Address - Country:US
Practice Address - Phone:509-888-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61521729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist