Provider Demographics
NPI:1821199753
Name:CLAYTON, WRENNA LAVETTE
Entity Type:Individual
Prefix:MRS
First Name:WRENNA
Middle Name:LAVETTE
Last Name:CLAYTON
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 1:13575 NE 54TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1037
Mailing Address - Country:US
Mailing Address - Phone:206-722-2205
Mailing Address - Fax:206-722-5457
Practice Address - Street 1:3207 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6031
Practice Address - Country:US
Practice Address - Phone:206-722-2205
Practice Address - Fax:206-722-5457
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0181371OtherWASHINGTON STATE L& I
WAG8334443Medicaid
WA5180662OtherAETNA
WA8918110OtherWASHINGTON STATE CRIME V
WACL5393OtherREGENCE
WA0181371OtherWASHINGTON STATE L& I