Provider Demographics
NPI:1578027926
Name:CLAVE, WILLIAM LAWRANCE (PSS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAWRANCE
Last Name:CLAVE
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 NW REIMAN ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6177
Mailing Address - Country:US
Mailing Address - Phone:541-758-3000
Mailing Address - Fax:
Practice Address - Street 1:865 NW REIMAN ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6177
Practice Address - Country:US
Practice Address - Phone:541-758-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003293175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist