Provider Demographics
NPI:1639779879
Name:CLAYSON, KAITLIN MICHELLE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELLE
Last Name:CLAYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32275 E LOOP RD
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6553
Mailing Address - Country:US
Mailing Address - Phone:541-324-0732
Mailing Address - Fax:
Practice Address - Street 1:7401 W GRANDRIDGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7831
Practice Address - Country:US
Practice Address - Phone:206-388-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician