Provider Demographics
NPI:1508395047
Name:WARNER, CLAYTON DENNIS SR
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:DENNIS
Last Name:WARNER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 HWY 2
Mailing Address - Street 2:P.O. BOX 1
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779
Mailing Address - Country:US
Mailing Address - Phone:218-729-4669
Mailing Address - Fax:
Practice Address - Street 1:7043 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MN
Practice Address - Zip Code:55779-9690
Practice Address - Country:US
Practice Address - Phone:218-729-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency